title: Patient-performed seton irrigation for the treatment of deep horseshoe fistula.
abstract: OBJECTIVE
  Compared with total fistulotomy using a lay-open technique for treatment of deep horseshoe or deep posterior complex anal fistula, the seton drainage method has reduced damage of the external anal sphincter. However, conventional seton drainage is burdensome to patients, requiring frequent clinic visits for wound management during prolonged periods while the drainage tube is in place. To reduce the number of clinic visits and facilitate healing, we devised a patient-performed seton irrigation technique and compared the results with a conventional loose seton to determine its clinical usefulness.
  
  
  METHODS
  We reviewed medical records of 24 patients who were diagnosed with deep horseshoe fistula and underwent surgery between January 1999 and December 2004. Twelve patients treated through December 2001 received a conventional loose seton. Twelve patients treated from January 2002 performed self-irrigation via the seton. These 2 groups were compared regarding duration of purulent discharge, length of time until seton removal, and recurrence rate.
  
  
  RESULTS
  The mean duration of purulent discharge was 18.75 (range, 15-24) days for self-irrigation vs 29.75 (24-37) days for conventional loose seton treatment (P < .001). The mean time to removal of the seton was 21.58 (18-29) days for self-irrigation vs 32.58 (28-39) days for conventional treatment (P < .001). The recurrence rate after surgery was 8.3% for self-irrigation vs 16.7% for conventional treatment (P > .99).
  
  
  CONCLUSIONS
  Patient-performed seton irrigation shortens the period of treatment and healing through more effective wound management, and we propose this technique as a useful new method of treating deep horseshoe fistula.
authors.affiliation: Department of Surgery, Pusan National University School of Medicine, Pusan, Korea.
authors.forename: Donghwi
authors.initials: D
authors.lastname: Choi
authors.forename: Hyun
authors.initials: H
authors.lastname: Sung Kim
authors.forename: Hyung-Il
authors.initials: HI
authors.lastname: Seo
authors.forename: Nahmgun
authors.initials: N
authors.lastname: Oh
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012003:Rectal Fistula / Q000601:surgery*; D012008:Recurrence; D012189:Retrospective Studies; D012648:Self Care; D018709:Statistics, Nonparametric; D007507:Therapeutic Irrigation / Q000379:methods*; D016896:Treatment Outcome; D014945:Wound Healing / Q000502:physiology