title: The Snug Seton: short and medium term results of slow fistulotomy for idiopathic anal fistulae.
abstract: 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.
  
  
  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.
  
  
  CONCLUSIONS
  In the short and medium term, the 'snug' seton is a safe and effective addition to the fistula surgeon's armamentarium.
authors.affiliation: Centre for Academic Surgery, Institute of Cellular and Molecular Science, The Royal London Hospital, Barts, London, UK.
authors.forename: T M
authors.initials: TM
authors.lastname: Hammond
authors.forename: C H
authors.initials: CH
authors.lastname: Knowles
authors.forename: T
authors.initials: T
authors.lastname: Porrett
authors.forename: P J
authors.initials: PJ
authors.lastname: Lunniss
mesh_terms: D000328:Adult; D000368:Aged; D001003:Anal Canal / Q000601:surgery*; D004129:Dimethylpolysiloxanes; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction; D012003:Rectal Fistula / Q000601:surgery*; D012189:Retrospective Studies; D012828:Silicones; D013536:Suture Techniques; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D004129:Dimethylpolysiloxanes; D012828:Silicones; C013830:baysilon