Functional results after seton treatment of high transsphincteric anal fistulas.

OBJECTIVE

To evaluate the functional outcome after seton treatment of high transsphincteric anal fistulas.

DESIGN

Retrospective study.

SETTING

University hospital, Sweden.

SUBJECTS: 29 patients (8 women, mean age 46, range 25-71) with high transsphincteric anal fistulas 1983-1992.

INTERVENTIONS: Setons were inserted in the anal fistulas in all patients.

MAIN OUTCOME MEASURES: Anal continence evaluated by a questionnaire a mean of 46 months postoperatively. Clinical data were collected from the patients' records.

RESULTS

All four patients with inflammatory bowel disease had some incontinence. Of the remaining 25 patients, 11 (44%) complained of incontinence and 2 (8%) developed recurrent fistulas. Incontinence was more common when the seton was tightened at the last procedure (7/9) compared with those in which the tissue enclosed by the seton was divided (4/16, p = 0.03). No other preoperative or operative characteristic significantly influenced the risk of incontinence.

CONCLUSION

Incontinence is common after seton treatment of high transsphincteric anal fistulas. The risk seems to be higher when the muscle remains viable after a period of seton treatment.