title: Non-cutting setons for progressive migration of complex fistula tracts: a new spin on an old technique.
abstract: OBJECTIVE
  We introduced a modification of the loose seton for high transsphincteric fistula which involved daily self-rotation of the seton by 360°, which we call the progressive migration technique. The outcomes were evaluated.
  
  
  METHODS
  A retrospective review was undertaken of all operations for anal fistula performed by a single colorectal surgeon from Jan. 2002-Dec. 2007. Twenty-four patients with high transsphincteric fistulas were treated with loose, 0-silk setons. Patients were asked to rotate the seton daily, one revolution in each direction, pulling the knot through the fistula tract. Follow-up was done by phone with questionnaires to address incontinence pain scores, satisfaction, and recurrence.
  
  
  RESULTS
  The patients' mean age was 48 years (range, 22-77 years), with M/F ratio of 3:1. The mean duration for seton in place was 14 months (range, 2-40 months). Follow-up ranged from 12-81 months (mean, 45 months). The progressive migration technique resulted in the gradual healing of the fistula tract in 75% of patients (n = 18), with no recurrence (setons completely worked their way to the surface [n = 9], or tract migration was extensive to allow a safe completion fistulotomy [n = 9]). All were fistula free. Twenty-five percent (n = 6) had Crohn's disease. Reported incontinence rates were 0% for solid and liquid stool and 8% (n = 2) for flatus. Twenty-five percent (n = 6) tolerated the setons poorly, and an alternative procedure was performed.
  
  
  CONCLUSIONS
  Simple daily self-rotation of a heavy silk seton, resulting in progressive migration of the fistula tract, is an alternative technique for treating complex, high transsphincteric anal fistulas.
authors: Department of Surgery, Providence Hospital and Medical Centers, 16001 W. Nine Mile Road, Southfield, MI 48075, USA. drsgokul@yahoo.com
authors: Gokulakkrishna
authors: G
authors: Subhas
authors: Aditya
authors: A
authors: Gupta
authors: Saravana
authors: S
authors: Balaraman
authors: Vijay K
authors: VK
authors: Mittal
authors: Ralph
authors: R
authors: Pearlman
mesh_terms: D000328:Adult; D000368:Aged; D003710:Demography; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012003:Rectal Fistula / Q000601:surgery*; D013536:Suture Techniques; D013537:Sutures; D016896:Treatment Outcome; D055815:Young Adult