SETON TREATMENT OF PERIANAL FISTULA WITH HIGH ANAL OR RECTAL OPENING

Staged fistulotomy with a seton is considered to decrease the high inc idence of continence disorders after surgical incision of a fistula. T his retrospective study reports the results of the two-stage procedure with special emphasis on faecal continence. Thirty-four patients (age d between 20 and 57 years) were treated between 1981 and 1990 with a t wo-stage seton procedure for anal fistula (16 extrasphincteric and 18 trans-sphincteric) with a high anal or rectal internal opening. Thirty -one patients had normal preoperative continence. There were two recur rences. All trans-sphincteric fistulas healed. Twenty-nine patients wi th preoperative normal faecal control were available for follow-up. Po stoperative continence was normal in 12 patients (category A according to Browning and Parks classification(2)); five patients had no contro l over flatus (B), 11 were incontinent for liquid stool or flatus (C) and one had continued faecal leakage (D). The two-stage seton techniqu e is not recommended for fistulas with high anal or rectal openings.