title: A decade of selective use of adjustable cutting seton combined with fistulotomy for anal fistula.
abstract: Previous studies have demonstrated that the division of sphincter muscle in the treatment of anal fistula may precipitate fecal incontinence. Cutting setons may pose a particular risk of unrecoverable injury to the sphincter apparatus. To evaluate if the use of an adjustable cutting  seton mitigates this risk, we performed a retrospective review of all patients operated on for anal fistulae in a 10-year period by a single surgeon. Adjustable cutting setons (consisting of heavy silk ligature with patient-controllable tension) were used selectively. Forty-seven patients  met the study criteria. Ninety-four per cent of the fistulae treated were transsphincteric. All of the fistulae were treated with at least partial fistulotomy. Ninety-nine per cent of patients were followed to completion of treatment. One (2%) patient subsequently developed fecal incontinence,  and four (9%) developed a recurrent or persistent fistula in the same location. Adjustable cutting setons have been used in our practice with a high success rate and low risk of complications. Our data support adjustable cutting setons as a useful tool in the surgeon's repertoire for treating  fistulae that involve the anal sphincter complex.
authors: Kaiser Permanente Los Angeles Medical Center, Los Angeles, California 90027, USA.
authors: Allen
authors: A
authors: Kamrava
authors: J Craig
authors: JC
authors: Collins
mesh_terms: D001003:Anal Canal / Q000503:physiopathology / Q000601:surgery*; D013505:Digestive System Surgical Procedures / Q000379:methods*; D004867:Equipment Design; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000517:prevention & control; D020127:Recovery of Function; D012003:Rectal Fistula / Q000601:surgery*; D012189:Retrospective Studies; D013536:Suture Techniques / Q000295:instrumentation*; D013997:Time Factors; D016896:Treatment Outcome