Modified loose-seton technique for the treatment of complex anal fistulas

Aim The aim of treatment of anal fistula is to remove the track avoiding while ensuring faecal continence. We report the results of a technique that preserves the external anal sphincter in patients with complex anal fistulas. Method Between 2006 and 2009, 18 patients underwent surgery for a complex anal fistula using this technique. It involved initial identification and partial laying open of the fistulous tract including the internal sphincter distal to the dentate line without transecting the external sphincter. A loose‐seton is placed around the external sphincter and is not removed until the internal orifice has migrated towards the perianal skin. Results Of the 18 patients [mean age 42 (31–65) years] 11 were female and the median follow‐up was 16 months. The mean time for removal of the seton, after discharge had ceased, was 4 (3–12) months. The preoperative faecal incontinence Wexner score was 0 (0–9) and postoperatively 0 (0–8). Conclusion The technique shows excellent results in the treatment of complex anal fistulas with conservation of fecal continence.