Published: 2020-06-25

Role of seton versus conventional techniques in the management of anorectal fistulas

Mohammad Sadik Akhtar, Sheikh Saif Alim, Mohammad Habib Raza, Wasif Mohammad Ali


Background: This study was conducted to compare the use of different setons with conventional management like fistulotomy and fistulectomy in terms of healing (after 1 and 3 months), recurrence and incontinence.

Methods: This was a retrospective non-randomized study conducted at JNMCH, Aligarh from January 2018 to June 2019. Patients included- patients (males and females) of age group 18-70 years, patients giving consent. Patients excluded- fistula secondary to- Crohn’s disease, tuberculosis, malignancy, recurrent fistula, pregnant females, immuno-suppressed patients.

Results: After 1 month, 17 out of 24 patients (70.8%) of fistulotomy, 48 out of 68 patients (70.6%) of seton group and 21 out of 32 patients (65.6%) of fistulectomy group had their wounds healed (p=0.8693). After 3 months, 19 out of 24 (79.2%) patients of fistulotomy, 61 out of 68 (89.7%) of seton, and 24 out of 32 patients (75%) with fistulectomy had their wound healed (p=0.1374). Recurrence was observed in 5 out of 24 patients of fistulotomy, 10 out of 68 patients of seton use and 5 out of 32 patients with fistulectomy (p=0.7788). 6 out of 24 patients (25%) had incontinence after fistulotomy, 7 out of 68 (10.3%) of seton group and 8 out of 24 (25%) after fistulectomy (p=0.0944). Healing was higher in patients of non-cutting setons as compared to cutting seton (p=0.0252). After 3 months, no difference was observed (p=0.1245). Recurrence higher in cutting setons as compared to non-cutting setons (p=0.0187).

Conclusions: Setons are safe, low-cost, less invasive, precise, and cost-effective option for treating simple and complex fistula-in-ano.



Anorectal fistulas, Fistulectomy, Fistulotomy, Perianal abscess, Setons

Full Text:



Henrichsen S, Christiansen J. Incidence of fistula-in-ano complicating anorectal sepsis: a prospective study. Br J Surg. 1986;73:371-2.

Zanotti C, Martinez-Puente C, Pascual I, Pascual M, Herreros D, García-Olmo D. An assessment of the incidence of fistula-in-ano in four countries of the European Union. Int J Colorect Dis. 2007;22:1459-62.

Sainio P. Epidemiology. In: Robin KS, Lunniss PJ, eds. Anal fistula. London: Chapman & Hall; 1996: 1-11.

Gabriel WB. Results of an experimental and histological investigation into seventy-five cases of rectal fistulae. Proc R Soc Med. 1921;14:156-61.

Theerapol A, So BY, Ngoi SS. Routine use of setons for the treatment of anal fistulae. Singapore Med J. 2002;43:305-7.

Parks AG, Gordon PH, Hardcastle JD. A classification of fistula in ano. Br J Surg. 1976;63:1-12.

Kodner IJ, Mazor A, Shemesh EI, Fry RD, Fleshman JW, Birnbaum EH. Endorectal advancement flap repair of rectovaginal and other complicated anorectal fistulas. Surgery. 1993;114:682-90.

Mizrahi N, Wexner SD, Zmora O, Giovanna Da Silva MD, Efron J, Weiss EG, et al. Endorectal advancement flap. Dis Colon Rectum. 2002;45(12):1616-21.

Ritchie R, Sackier JM, Hodde JP. Incontinence rates after cutting seton treatment for anal fistula. Colorect Dis. 2009;11(6):564-71.

Vial M, Parés D, Pera M, Grande L. Faecal incontinence after seton treatment for anal fistulae with and without surgical division of internal anal sphincter: a systematic review. Colorect Dis. 2010;12(3):172-8.

Gurer A, Ozlem N, Gokakin AK, Ozdogan M, Kulacoglu H, Aydin R. A novel material in seton treatment of fistula-in-ano. Am J Surg. 2007;193(6):794-6.

Vatansev C, Alabaz Ö, Tekin A, Aksoy F, Yılmaz H, Kücükkartallar T, et al. A new seton type for the treatment of anal fistula. Digest Dis Sci. 2007;52(8):1920-3.

Pearl RK, Andrews JR, Orsay CP, Weisman RI, Prasad ML, Nelson RL, et al. Role of the seton in the management of anorectal fistulas. Dis Colon Rectum. 1993;36(6):573-9.

Eitan A. The use of the loose seton technique as a definitive treatment for recurrent and persistent high trans-sphincteric anal fistulas: a long-term outcome. J Gastrointest Surg. 2009;13:1116-9.

Poon CM, Dennis CK, Cheung MH, Raymond SK, Leong HT. Recurrence pattern of fistula-in-ano. J Gastrointest Liver Dis. 2008;17:53-7.

Cirocchi R, Santoro A, Trastulli S, Farinella E, Di Rocco G, Vendettuali D, et al. Meta-analysis of fibrin glue versus surgery for treatment of fistula-in-ano. Annali Italiani Di Chirurgia. 2010;81(5):349-56.

Shanwani A, Nor AM, Amri N. Ligation of the intersphincteric fistula tract (LIFT): a sphincter-saving technique for fistula-in-ano. Dis Colon Rectum. 2010;53(1):39-42.