Comparison of Loose and Cutting Seton Methods in Anal Fistula Treatment

INTRODUCTION: The main objective in anal fistula surgery is the protection of continence. The incontinence rates after surgical treatment in cases with fistulas that contain more than 30% of external anal sphincter are increasing. In our study, we used the loose seton application with aim of comparing to the primary treatment like cutting seton. We aimed to determine the efficacy of treatment while comparing the results of patients treated with loose seton and cutting seton.
METHODS: The diagnosis of anal fistula in medical records between the date of January 2010-January 2020 was searched. The patients were divided into two groups as cases treated with loose seton(group 1, n: 126) and cases with cutting seton (group 2, n: 64). The groups were evaluated for demographic characteristics, clinical findings, complications, pain scores, clinical follow-up results, and recurrences.
RESULTS: 190 patients were included in the study and their mean age was 38.7 years. 145 cases were male and 45 were female. 115 cases were operated for lower transphincteric fistula and 75 ones for higher transsphincteric fistula. The mean length of the fistula tract was 2,2 cm (2-5,5). 39(20,6%) patients had a diagnosis of diabetes. The mean operation time was 19,8 minutes (13-35). 24(12,6%) patients had complications. The mean falling time of setons was 51.1 days(21-77) in 59 cases; whereas, 73(34-122) days in the loose seton group and 44 days (21-93) in the cutting seton group.
DISCUSSION AND CONCLUSION: No significant meaningful difference was found for treatment success despite a higher incidence of pain and incontinence in cutting seton applications.