European Journal of Molecular & Clinical Medicine

Abstract

Aim: The aim of the present study to determine the role of seton versus conventional techniques in the management of anorectal fistulas.
Methods: Total 100 patients with age group 18-65 years presented with primary fistula-in-ano and patients giving consent for the procedure were included in this study. Out of 100, 54 (54%) patients were placed in the group to be treated with seton placement in which 24 patients had a cutting seton placed through the fistulous tract and 30 patients had non-cutting seton made of rubber gloves placed through the fistulous opening. Remaining 46 (46%) patients were placed in another group to be treated by other means either with fistulotomy alone in 18 out of 46 patients or with fistulectomy done in 28 out of 46 patients.
Results: Out of 100 patients studied, 81 patients were males and 19 patients were females, with male to female ratio of 4.26:1. 54 patients out of 100 (54%) had a simple fistula, 25(25%) had multiple fistulae and 21 (21%) had complex fistulae. 54 patients who had a simple fistula and 25 patients who had a complex fistula were selected and treated with seton placement (54%) in which cutting seton was placed in 24 patients and seton made of rubber glove was placed in 30 patients. At the end of 1 month, 14 out of 18 patients (77.78%) who underwent fistulotomy had their wounds healed while in seton group, 37 out of 54 patients (68.52%) had their wounds healed. In fistulectomy group, 20 out of 28 patients (71.43%) had their wounds healed and the results were not found to be statistically significant (p=0.82). At the end of 3 months, 15 out of 18 (83.33%) patients had their wound healed who underwent fistulotomy, 47 out of 54 (87.04%) in patients of seton as the treatment modality, while with fistulectomy alone, complete wound healing was seen in 20 out of 28 patients (71.43%) but the results were not statistically significant (p=0.14). Recurrence was observed in 3 out of 18 patients of fistulotomy, 8 out of 54 patients of seton use and 4 out of 28 patients who underwent fistulectomy, but the results were comparable (p=0.79). 5 out of 18 patients (27.78%) were observed as having incontinence who underwent fistulotomy alone, 5 out of 54 (9.26%) in patients of seton group and 6 out of 28 (21.43%) had incontinence in fistulectomy group but the results were statistically insignificant (p=0.08).
Conclusion: Setons are safe, low-cost, less invasive, precise, and cost-effective option for treating simple and complex fistula-in-ano.