Evaluation of the cutting seton as a method of treatment for perianal fistula

BACKGROUND: Perianal fistulas are distressing for the patient and sometimes a challenge for the surgeon. Different methods for the treatment of perianal fistulas have a range of success rates and use of the cutting seton is still debatable. OBJECTIVES: We evaluated the recurrence, success rate and incontinence with the cutting seton method for treating perianal fistula. DESIGN: Prospective, descriptive study. SETTING: Al-Hada Armed Forces Hospital, Department of General Surgery, Taif, Saudi Arabia. PATIENTS AND METHODS: We studied all patients with high perianal fistula admitted to the department of general surgery in our hospital with a diagnosis of perianal fistula in the period from December 2012 to December 2013 (12 months). Patients were followed for postoperative recurrence and incontinence rate. MAIN OUTCOME MEASURE(S): The primary outcome measured was either complete cure or recurrence. RESULTS: Fifty-one patients underwent cutting seton insertion for fistula in ano. The recurrence rate was 9.8%. The postoperative rate of incontinence was 15.7% to flatus and 5.9% to fluid stools. There was no incontinence to solid stools. CONCLUSION: The cutting seton is a valid option for a complex fistula in ano, but in female patients and those with previous peri-anal surgery, other surgical options are advised. LIMITATIONS: Patients with low perianal fistula, Crohn’s disease, acute perianal abscess and patients with major incontinence were excluded.