Aim: Anorectal fistulas have been a common surgical problem since ancient times. Age-old seton techniques are still practicedsuccessfully in the treatment of complex anal fistulas. Many variations in materials and techniques are described in the literature. The selection of a seton type and technique depends on personal preferences. Our aim was to put together all the available variations in materials and techniques for seton treatment. This comprehensive review will help the surgeon to become more familiar with the various options available with regard to materials and techniques. Methods: A review of the literature using Medline was done using the Key Words ‘anal fistula’ and ‘seton’. All articles published in English were reviewed. The articles which had variations in materials and techniques for seton treatment were studied. Results: Various aspects of variations in materials, insertion techniques, maintenance of tension, mechanisms of action, drainage techniques and changing the seton have been elaborated in detail. Conclusions: Throughout this paper we present the various available variations in setons with regard to materials, placement and maintenance techniques. This study will help clinicians in choosing a new seton variation or modifying their current method of treatment with setons.
Intraoperative parathyroid hormone monitoring (IOPM), in use for the last 15 years, has facilitated focused parathyroidectomy. We undertook this study to determine if a drop in IOPT hormone levels below 50 per cent of baseline were sufficient to terminate the procedure. We conducted a retrospective chart review (January 2007 to September 2010) of 104 patients who underwent initial parathyroidectomies with IOPM by general surgeons for primary hyperparathyroidism. Patients were followed up for serum calcium levels (range, 6 to 48 months). The number of specimens excised was significantly decreased when IOPT hormone levels dropped to greater than 50 per cent and came within the normal range earlier. Moreover, for single-gland parathyroid adenomas, once the parathyroid hormone values dropped to less than 50 per cent in the 5-minute sample, they continued to decrease in the subsequent samples. In 23 cases requiring further exploration, the parathyroid hormone values had already decreased to greater than 50 per cent in 14 cases but had not normalized (reference range, 8 to 74), leading to additional exploration. However, subsequent pathologic analysis showed that the initial gland removed was the adenoma in all these cases. A drop in the initial 5-minute parathyroid hormone value to less than 50 per cent of the baseline should serve as sufficient evidence to terminate the procedure. This would translate into significant laboratory and personnel cost savings over time. However, this should be carefully correlated with preoperative ultrasound/sestamibi findings.
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