title: Long-term results of the cutting seton for high anal fistula.
abstract: BACKGROUND
  No single procedure for high anal fistula delivers a high cure rate while also completely protecting sphincter function. This paper reports our long-term results with the cutting seton for high fistulae and draws comparisons with advancement flap and ligation of intersphincteric fistula track (LIFT) procedures.
  
  
  METHODS
  A retrospective study of prospectively collected data in consecutive patients undergoing treatment with cutting seton for high cryptoglandular fistulae was carried out. A strict protocol dictated tightening intervals of at least 4 weeks and no muscle division. In 59 patients (male : female = 39:20) followed-up at mean 9.4 years (range 1.7-15.6 years) healing rates, continence (St Mark's score 0-24), patient-perceived overall change in bowel control (-5 to +5), faecal incontinence quality of life (FIQL) and overall patient satisfaction (visual analogue score 0-10) were assessed.
  
  
  RESULTS
  Primary and secondary healing rates were 93% and 98%. Mean continence score was 4.1, significantly worse in women than men (median 6, range 0-22 versus median 1, range 0-17; P = 0.006). Seventy-eight per cent of patients had normal continence or minor incontinence (score 0-6), 13.5% moderate incontinence (score 7-12) and 8.5% severe incontinence (score >12). Sixty-three per cent of patients had no change or improved patient-perceived overall bowel control. Mean FIQL scores were high and significantly correlated with continence. Median satisfaction score was 9.
  
  
  CONCLUSIONS
  Cutting seton for high anal fistula achieved healing in 98% with good continence in the majority, particularly in males, and a high level of patient satisfaction. Multicentre prospective studies are needed to adequately compare cutting seton, flap and LIFT procedures.
authors.affiliation: Department of Colorectal Surgery, St George Hospital, Sydney, New South Wales, Australia.|University of New South Wales, Sydney, New South Wales, Australia.
authors.forename: Vicki
authors.initials: V
authors.lastname: Patton
authors.affiliation: Department of Colorectal Surgery, St George Hospital, Sydney, New South Wales, Australia.|Mount Elizabeth Novena Specialist Centre, Affinity Surgery Centre, Singapore.
authors.forename: Chung Ming
authors.initials: CM
authors.lastname: Chen
authors.affiliation: Department of Colorectal Surgery, St George Hospital, Sydney, New South Wales, Australia.|University of New South Wales, Sydney, New South Wales, Australia.
authors.forename: David
authors.initials: D
authors.lastname: Lubowski
mesh_terms: D000328:Adult; D000368:Aged; D005242:Fecal Incontinence / Q000209:etiology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008026:Ligation / Q000379:methods*; D008297:Male; D008875:Middle Aged; D063868:Patient Outcome Assessment; D017060:Patient Satisfaction; D011788:Quality of Life; D012003:Rectal Fistula / Q000150:complications / Q000601:surgery*; D012008:Recurrence; D012189:Retrospective Studies; D013524:Surgical Flaps; D014945:Wound Healing / Q000502:physiology
keywords: anal fistula; complex anal fistula; seton