title: Elastic one-stage cutting seton for the treatment of high anal fistulas: preliminary results.
abstract: BACKGROUND
  The management of high and complicated anal fistulas remains a therapeutic challenge, and the oldest and theoretically the simplest technique is to use a seton. In this article, we document our recent experience in managing high anal fistulas with a simple modification of the cutting seton.
  
  
  METHODS
  Surgical outcomes of patients treated by the elastic cutting seton for anal fistulas that involved more than half of the sphincter muscles or for anterior trans-sphincteric fistulas in female patients were analyzed. The elastic seton, which was created by cutting a thin (2-3 mm) circular strip from a surgical glove, including its thicker sleeve, was inserted through the remaining tract in a double-strand fashion, and then tied on the sphincter with two knots in a slightly tight manner.
  
  
  RESULTS
  Complete healing was achieved in 9 cases (45%) at 1 month and in all cases (100%) at 3 months postoperatively. Recurrent fistula was noted in a single patient (5%) at 8 months. Worsening of preoperative continence was noted in 4 patients (20%). However, the postoperative incontinence score (0.70+/-1.22) did not differ significantly from the preoperative score (0.41+/-0.41; p=0.059, Wilcoxon's test).
  
  
  CONCLUSIONS
  The preliminary results of this series suggest that the elastic cutting seton may be a valid alternative for the treatment of high anal fistulas. The possible positive contribution of the slow and stable cutting of the sphincter on the maintenance of continence is further supported. An important practical disadvantage of the conventional seton treatment, namely the need for postoperative adjustments, is also eliminated.
authors.affiliation: Division of Colorectal Surgery, Department of Surgery, Gazi University, Medical School, Ankara, Turkey. bmentes@gazi.edu.tr
authors.forename: B B
authors.initials: BB
authors.lastname: Mentes
authors.forename: S
authors.initials: S
authors.lastname: Oktemer
authors.forename: T
authors.initials: T
authors.lastname: Tezcaner
authors.forename: C
authors.initials: C
authors.lastname: Azili
authors.forename: S
authors.initials: S
authors.lastname: Leventoğlu
authors.forename: M
authors.initials: M
authors.lastname: Oğuz
mesh_terms: D000328:Adult; D005260:Female; D005932:Gloves, Surgical; D006801:Humans; D008297:Male; D008875:Middle Aged; D012003:Rectal Fistula / Q000601:surgery*; D013536:Suture Techniques / Q000295:instrumentation*; D016896:Treatment Outcome