Long-term seton drainage for high anal fistulas in Crohn's disease--a sphincter-saving operation?
METHODS
Forty-one consecutive patients with Crohn's disease who underwent long-term seton drainage for high transsphincteric, suprasphincteric, or extrasphincteric anal fistula from 1985 to 1993 were reviewed. The subsequent associated procedure was simple seton removal (18), secondary 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 removal 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.


CONCLUSIONS
Long-term seton drainage for high and fistula in Crohn's disease is efficacious in both treating sepsis and preserving anal sphincter function.
Faucheron
J L
JL
Department of Alimentary Tract Surgery, Saint-Antoine Hospital, Paris, France.
Saint-Marc
O
O
Guibert
L
L
Parc
R
R
D000293:Adolescent; D000328:Adult; D000368:Aged; D003424:Crohn Disease / Q000150:complications*; D004322:Drainage / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012003:Rectal Fistula / Q000209:etiology / Q000601:surgery*; D013997:Time Factors; D016896:Treatment Outcome