title: The role of loose seton in the management of anal fistula: a multicenter study of 200 patients.
abstract: BACKGROUND
  Perianal abscesses and fistulae-in-ano are a common anorectal complaint causing significant distress to patients, and present a considerable treatment challenge. Principal of treatment is achieving closure of the fistula while maintaining continence. There are numerous treatment approaches with large debate about which method is "ideal." Our aim was to assess the tolerance and efficacy of loose seton placement in the treatment for fistula-in-ano.
  
  
  METHODS
  We performed a retrospective multicenter review of the management of anal fistulae with loose seton placement over a three-year period. All patients underwent a standardized procedure, and were rescheduled for an elective change of seton until fistula resolution. Patients' demographics, medical history, comorbidities, overall number and time interval between seton placements, tolerance, and morbidity of the procedure were recorded.
  
  
  RESULTS
  A total of 200 consecutive patients had loose seton placement. 69.5 % (n = 139) were males, and mean age was 42.6 years. The median number of setons required for each patient was 3 (range 1-8; mean 2.84). The mean interval between changes was 3.08 months (range 2-4 months). All patients had successful clearance of fistula. The procedure was well tolerated in 96 % of patients (n = 187). Only 1 % (n = 2) could not tolerate the presence of seton due to significant discomfort. Fistula recurrence rate was 6 % (n = 12).
  
  
  CONCLUSIONS
  Recently, newer treatment modalities have been reported with enthusiasm. However, there remains a lack of strong statistical evidence of efficacy to support their use. Overall, loose seton placement remains a well-tolerated, pragmatic low-cost solution to this common and difficult condition as evident by our study.
authors.affiliation: Department of Surgery, St Vincent's University Hospital, Elm Park, Dublin 4, Ireland, kellym11@tcd.ie.
authors.forename: M E
authors.initials: ME
authors.lastname: Kelly
authors.forename: H M
authors.initials: HM
authors.lastname: Heneghan
authors.forename: F D
authors.initials: FD
authors.lastname: McDermott
authors.forename: G J
authors.initials: GJ
authors.lastname: Nason
authors.forename: C
authors.initials: C
authors.lastname: Freeman
authors.forename: S T
authors.initials: ST
authors.lastname: Martin
authors.forename: D C
authors.initials: DC
authors.lastname: Winter
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D013505:Digestive System Surgical Procedures / Q000009:adverse effects / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000601:surgery; D012003:Rectal Fistula / Q000209:etiology / Q000601:surgery*; D012008:Recurrence; D012189:Retrospective Studies; D013536:Suture Techniques; D016896:Treatment Outcome