Incontinence rates after cutting seton treatment for anal fistula

Abstract

Objective To determine the incidence of anal incontinence after the use of cutting seton treatment for anal fistula.Method Literature searches were performed on PubMed, MEDLINE and Google Ô Scholar using the words 'cutting seton(s)', 'seton(s)' and 'anal fistula'. An analysis of the data in the collected references was performed.Results The average rate of incontinence following cutting seton use was 12%. The rate of incontinence increased as the location of the internal opening of the fistula moved more proximally. In the studies that described the types of incontinence, liquid stool was the most common followed closely by flatus incontinence. Incontinence associated with the treatment of fistulas defined as nonspecific cryptoglandular in nature was 18%.Conclusion The high incontinence rates that result from the use of cutting setons suggest that this commonly used therapy can damage the continence musculature. Other techniques that do not involve cutting the sphincter, when available, should be preferred, especially for higher fistulas.

Autologous adipose tissue-derived stem cells treatment demonstrated favorable and sustainable therapeutic effect for Crohn's fistula

“…Although a short-term effect is generally achieved by surgery, poor healing and a high rate of fistula recurrence are reported by many studies [6][7][8]. The most serious problem after surgical intervention is the relatively high incidence of postoperative anal incontinence caused by sphincter injury during the procedure [9,10].…”

Ligation of the intersphincteric fistula tract (LIFT) to treat anal fistula: early results from a prospective observational study

“…On the other hand, surgical treatments for high and complex fistulas may result in variable degree of anal sphincter impairment. Various alternative surgical options, such as flap repair, fibrin glue injection, seton drainage and fistula track plug insertion with variable success rates, have been proposed [6][7][8][9]. Usually, less invasive approaches do not jeopardize continence, but healing rates can be very low.…”

Controversies in Fistula in Ano

“…The preferred method of using a seton is to use it as a "draining" seton rather than a "cutting" seton. Although a cutting seton can have better success rate as high as 99 % [17], it can cause severe discomfort to the patient & can have an incidence of incontinence as high as 18 %-25 % [18,19]. Draining seton can have a persistent fistula rate ranging between 20 % and 40 %, but with a low incidence of incontinence.…”