Elastic Seton Placement in Treatment of Complex Anal Fistula: Analysis of 44 Patients

Aim: There is no consensus on the treatment of complex anal fistula. Although there are various methods, the seton placement is commonly used in the treatment. Setons can be placed tight or loose. Loose setons are commonly used when prolonged drainage is required. Tight setons have disadvantages in terms of patient comfort due to painful tightening periods and adverse effects on continence. Method: The data of 48 patients admitted to our outpatient clinic and operated for complex anal fistula between January 2015 and December 2016 was retrospectively analyzed. Demographic data, fistula characteristics, coexisting inflammatory bowel disease (IBD), abscess formation, perioperative details, postoperative complications, and incontinence and recurrence rates were evaluated. Results: Forty-four patients who underwent elastic seton placement were enrolled in the study. Four patients for whom the internal opening could not be identified were excluded. The female to male ratio was 14/30 and median age was 43.5 years (18-83 years). There were abscess in 19 patients and coexisting IBD in 5 patients. The median operative time was 22 minutes (11-50 min), and the duration of hospital stay was one day except for 2 patients. None of patients had postoperative complications. Twenty-five patients (56.8%) had recovered at the end of the first month with one-stage operation. Eighteen patients required second or third procedures, 5 of them due to premature tearing of the seton. One patient had 5 operations. Full recovery was seen in 40 patients (90.9%) at the end of 3 months and none of the patients complained of incontinence. The median follow-up period was 11 months (6-21 months) and 2 patients (4.5%) had recurrence during this period. Conclusion: Elastic setons can be used as an alternative to tight setons with satisfactory clinical success and the advantage of no need for painful tightening periods.