[Treating high anal fistulae with slow cutting seton].
BACKGROUND
The aim was to determine the incidence of anal incontinence, recurrence rate and patient satisfaction after using slow-cutting setons for transsphincteric anal fistula repair.


METHODS
A retrospective study with prospective follow up in 58 patients who had undergone surgery for transsphincteric perianal fistulas with a slow-cutting seton. A total of 17 patients were excluded or lost in the follow up period. A questionnaire was send to 41 cases to the severity of incontinence for gas, liquid and stool according to the Wexner-score. Recurrence rate, sick leave and satisfaction with the treatment were estimated.


RESULTS
The questionnaire was returned from 34 patients. In all 23 men and 11 women had the seton tightened for the first time after a mean period of 32 days. The mean number of tightenings was five (range: 2-9). The mean duration of treatment was 256 days (range: 61-634). A total of four patients (12%) experienced recurrence. Twenty-one patients (61,7%) had a Wexner score of one or more. Eight patients (23,5%) scored more than four. A total of 28 patients (82%) were 75-100% satisfied with the treatment. Two patients (6%) were absolutely dissatisfied, and were considered failures. We found no association between the reported satisfaction with the treatment and the degree of incontinence.


CONCLUSIONS
Despite a very high level of satisfaction among the patients, the high rate of incontinence suggests that other non-invasive techniques should be used as first-line treatment of anal fistulas. In cases where multiple attempts at repair have failed, the slow-cutting seton may be the best option.
Kirurgisk Afdeling K, Bispebjerg Hospital, DK-2400 København NV, Denmark. annalykke@dadlnet.dk
Anna
A
Lykke
Joen
J
Steendahl
Peer A
PA
Wille-Jørgensen
D000328:Adult; D000368:Aged; D015331:Cohort Studies; D005242:Fecal Incontinence / Q000209:etiology / Q000628:therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction; D011446:Prospective Studies; D012003:Rectal Fistula / Q000601:surgery*; D012008:Recurrence; D012189:Retrospective Studies; D012307:Risk Factors; D011795:Surveys and Questionnaires; D013536:Suture Techniques / Q000009:adverse effects; D016896:Treatment Outcome