title: Revisiting an ancient treatment for transphincteric fistula-in-ano 'There is nothing new under the sun' Ecclesiastes 1v9.
abstract: OBJECTIVE
  The history of treatments for fistula-in-ano can be traced back to ancient times. Current treatment of transphincteric fistulae is controversial, with many options available. We reviewed the history of treatment using cutting setons and present our series of transphincteric fistulae in the light of the series in the literature.
  
  
  METHODS
  Literature review and case series.
  
  
  METHODS
  Hospital based coloproctology service
  
  
  METHODS
  140 consecutive patients presenting with fistula-in-ano were included.
  
  
  METHODS
  The literature pertaining to treatment of transphincteric fistula was reviewed, along with the outcome of various treatment methods for this condition. Data were collected for 140 consecutive patients presenting with fistula- in-ano were assessed for fistula healing, recurrence and complications.
  
  
  RESULTS
  A total of 140 consecutive patients with fistula-in-ano were identified, of which 111 were cryptoglandular (79.3%). Eighty-one of these 111 were transphincteric (73.0%). At a median follow-up of 35 months (range, 2-83 months), 70 transphincteric fistulae had healed (86.4%), 10 were still undergoing treatment (12.3%) and one patient was lost to follow-up prior to treatment (1.2%). Two patients in this group required a stoma (2.5%), six patients developed recurrence (7.4%); three 'true' recurrences (3.7%). One (1.2%) developed a chronic fissure. There were no reported cases of incontinence.
  
  
  CONCLUSIONS
  The management of transphincteric fistula-in-ano is complex and controversial, for which no clear surgical procedure has gained acceptance as the gold standard. This study demonstrates that transphincteric fistulae can be successfully treated using cutting setons. A high healing rate (86.4%), low recurrence rate (7.4%) and a low complication rate (3.7%) are shown, which compares favourably with published rates over a long follow-up.
authors.affiliation: Department of Surgery, University Hospital Wales, Cardiff, CF14 4XW, UK solimanf@doctors.org.uk.
authors.forename: F
authors.initials: F
authors.lastname: Soliman
authors.affiliation: Nevill Hall Hospital, Abergavenny, Abergavenny, NP7 7EG, UK.
authors.forename: G
authors.initials: G
authors.lastname: Sturgeon
authors.affiliation: Department of Surgery, University Hospital Wales, Cardiff, CF14 4XW, UK Cardiff University, Cardiff University School of Medicine, Cardiff, Wales, CF14 4XN, UK.
authors.forename: R
authors.initials: R
authors.lastname: Hargest
mesh_terms: D058107:Abdominal Wound Closure Techniques; D000328:Adult; D001003:Anal Canal / Q000601:surgery*; D013505:Digestive System Surgical Procedures / Q000379:methods*; D004322:Drainage / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology; D012003:Rectal Fistula / Q000196:embryology* / Q000601:surgery*; D016896:Treatment Outcome; D014945:Wound Healing
keywords: gastroenterology; history; pathology; surgery