THE EFFECT OF SETON CUT THROUGH TECHNIQUE ON CONTINENCE AND RECURRANCE AFTER TREATMENT OF HIGH FISTULA-IN-ANO

Abstract

Objective: To determine the frequency of incontinence and recurrence after treatment of high Fistula-inano with cutting seton.

Material and Methods: This descriptive study was carried out in Surgical unit, Hayatabad Medical Complex, Peshawar from July 2007 to June 2008 and included 20 patients. After taking history, physical examination and baseline investigations, the patients were prepared with laxatives and rectal washes 24 hours prior to surgery and kept nothing per orally for 6 – 8 hours. All procedures were carried out under spinal/general anesthesia. All patients under went seton cut through procedure and were discharged on next day. Patients were followed up for tightening of seton and for observing complications like incontinence and recurrence, fortnightly till complete healing.

Results: Among total of 20 patients, there were 17 (85%) men and 3 (15%) women. The age range of our study population was from 24-70 years, with a mean range of 41 years. There were 18 trans-sphincteric and 02 suprasphincteric fistulae. The internal opening was posterior in 15, anterior in 2 and lateral in 3 patients. The time taken for seton to cut through the fistulous tract varied from 6 to 10 weeks. The Fistula completely healed up in all patients in 10 weeks time, but 01 (5%) patient developed recurrence of Fistula

after six months. Some patients complained of perianal soiling in the initial days, which settled down later on. 02(10%) patients experienced minor incontinence (flatus only) which settled down within 06 weeks of complete wound healing.

Conclusion: Seton cut through technique is safe and effective for high fistula-in-ano, with low incidence of recurrence and incontinence.