LONG-TERM SETON DRAINAGE FOR HIGH ANAL FISTULAS IN CROHNS-DISEASE - ASPHINCTER-SAVING OPERATION

METHODS: Forty-one consecutive patients with Crohn's disease who under went long-term seton drainage for high transsphincteric, suprasphincte ric, or extrasphincteric anal fistula from 1985 to 1993 were reviewed. The subsequent associated procedure was simple seton removal (18), se condary fistulotomy (7), rectal flap advancement (3), and proctectomy (2). Eleven patients still had the seton in place. RESULTS: Recurrence developed in seven patients (39 percent) undergoing simple seton remo val and in one patient undergoing rectal flap advancement. None of the patients treated by secondary fistulotomy developed a recurrence. At the end of follow-up, five patients (12 percent) required proctectomy mainly for severe proctitis, and five patients (12 percent) developed anal incontinence, which was severe in two. CONCLUSION: Long-term seto n drainage for high anal fistula in Crohn's disease is efficacious in both treating sepsis and preserving anal sphincter function.