Long-term results of cutting seton fistulotomy.
OBJECTIVE
To determine the long term outcome of cutting seton fistulotomy.


METHODS
An audit of fistula surgery using a cutting seton for cryptoglandular sepsis identified 32 patients treated between 1988-1996. The majority of the patients had a trans-sphincteric (26/32, 81%) fistula.


RESULTS
Fourteen (44%) had had previous fistula surgery before seton fistulotomy. Follow up was complete in 28 patients: 8 patients had recurrence (29%), 4 at a new site and 4 at the same site after apparent healing. Major incontinence was reported by 3 patients, minor incontinence by 7 and soiling by 5, but only 7 patients worsened after the cutting seton fistulotomy. Major incontinence was reported only by women who had a previous vaginal delivery.


CONCLUSIONS
Cutting setons do not always preserve continence in high trans-sphincteric and complex fistulas. Patients should be warned about a high recurrence rate after cutting seton fistulotomy. The use of a cutting seton for anterior fistulas in female patients with a history of vaginal delivery should be avoided because of the risk of incontinence.
Hasegawa
H
H
University Department of Surgery Queen Elisabeth Hospital Edgbaston, Birmingham.
Radley
S
S
Keighley
M R
MR
D000328:Adult; D000368:Aged; D005242:Fecal Incontinence / Q000209:etiology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D012003:Rectal Fistula / Q000601:surgery*; D012008:Recurrence; D013536:Suture Techniques; D016896:Treatment Outcome