MANAGEMENT OF FISTULA IN ANO

FIRM CUTTING SETON VS LOOSE SETON/FISTULOTOMY FOR SUPRASPHINCTERIC AND HIGH TRANS-SPHINCTERIC

Abstract

Aim: The aim of this study was to compare the efficacy and morbidity of two surgical procedures, firm cutting seton and
loose seton / fistulotomy in the management of suprasphincteric and high trans-sphincteric fistula in ano. Setting: Jinnah Hospital / Allama
Iqbal Medical college, Lahore. Period: June 1999 to January 2008. Methods: This is a prospective, randomized study of 50 consecutive
patients (25 in each group) suffering from suprasphincteric and high trans-sphincteric fistula in ano. Patients were randomly allocated one
of the two methods of treatment. In firm cutting seton, seton was repeatedly tightened with the interval of 15 days till the thread came out
whereas loose seton / fistulotomy was a two staged surgical procedure. Follow up was made for 12months to record the fistula recurrence,
anal incontinence, duration of complete wound healing and number of hospitalizations. Comparison was made using standard statistical
methods. Chi-square and Fisher's Exact test was applied for comparison. Results: There was no significant statistical difference between
the groups in age, sex and type of fistula. Patient treated with loose seton / fistulotomy required more than one hospitalization, more off
work and more expenditures as compared to firm cutting seton method. The rate of anal incontinence was more in patients treated with
loose seton / fistulotomy. Recurrence rate was almost the same in both groups. Conclusion: Both techniques are equally effective in
eradication of fistula but the rate of postoperative anal incontinence and duration of complete healing of the wound is more in patients treated
with loose seton / fistulotomy.