CUTTING SETON VERSUS 2-STAGE SETON FISTULOTOMY IN THE SURGICAL-MANAGEMENT OF HIGH ANAL FISTULA

Background The aim of this study was to compare the clinical results o btained with the cutting seton and the two-stage seton fistulotomy (TS SF) in the surgical management of high anal fistula. Methods The case records of 59 patients with high anal fistula of cryptoglandular origi n treated with cutting seton (n = 12) or TSSF (n = 47) over a 5-year p eriod were retrospectively reviewed. There was no difference between t he groups in age, sex distribution, or estimated percentage of anal sp hincter involved by the fistula. Follow-up was by a mailed questionnai re inquiring about fistula recurrence, incontinence, and degree of sat isfaction. Mean follow-up was similar in both groups (27 months for cu tting seton versus 33 months for TSSF). Comparisons were made by Stude nt t and chi(2) tests, as required. Results There were no differences in the rate of fistula recurrence between the groups treated with cutt ing seton or TSSF (one of 12 versus four of 47), difficulty holding ga s (Six of 12 versus 25 of 47), underwear staining (six of 12 versus 18 of 47), stool incontinence (three of 12 versus 12 of 27), overall inc ontinence (eight of 12 versus 31 of 47) and mean incontinence score (4 .9 versus 4.2). The fistula healing time and degree of satisfaction wi th the operation were not significantly different between the groups. One-half of the patients treated by TSSF had the seton removed under g eneral or epidural anaesthesia. Conclusion Both techniques are equally effective in eradicating the fistula, and both are associated with a similar rate of incontinence.