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The Snug Seton: short and medium term results of slow fistulotomy for idiopathic anal fistulae
Author(s) -
Hammond T. M.,
Knowles C. H.,
Porrett T.,
Lunniss P. J.
Publication year - 2006
Publication title -
colorectal disease
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.029
H-Index - 89
eISSN - 1463-1318
pISSN - 1462-8910
DOI - 10.1111/j.1463-1318.2005.00926.x
Subject(s) - medicine , fistulotomy , surgery , silastic , fistula , anal fistula , medium term , economics , macroeconomics
Objective To assess the short and intermediate outcomes of a modification of the traditional cutting seton technique, using a ‘snug’ silastic seton, to treat idiopathic anal fistulae. Patients and methods Between August 1997 and December 2002, 35 patients with idiopathic fistulae (4 female; age 26–76 years) underwent insertion of a ‘snugly’ tied 1 mm silastic seton (silicone nerve vessel retractor, Medasil ®), as definitive treatment. Short‐term assessment was performed by case note review. Patients were subsequently invited to participate in a medium‐term review. Results Twenty‐nine patients' notes (3 female) were available for short‐term analysis. Fistulae were classified as intersphincteric (9) and transsphincteric (20). The seton spontaneously cut out in 15/29 (52%) after a median of 24 weeks. In 14 patients the seton enclosed residual tissue (< 5 mm) required division as a day case procedure, at a median of 35 weeks. All fistulae healed but 10/29 (34%) patients (1 female; 8 transsphincteric) experienced minor incontinence. Sixteen patients participated in a medium‐term review at a median of 42 months; 7 had experienced early continence disturbance. No patient suffered recurrence, but minor incontinence persisted in 4/16 (25%) patients (0 females; 3 transsphincteric). All patients were at least ‘satisfied’ with the outcome. Conclusion In the short and medium term, the ‘snug’ seton is a safe and effective addition to the fistula surgeon's armamentarium.