Abstract
High peri anal fistula is a problematic condition that constitutes a challenge for both the patient and the surgeon . Different lines of management are available in the surgeon armamentarium. Seton comprise one of the methods of management that has its role in management.
Thirty patients with high peri anal fistulae were selected (22 males and 8 females) with an average age ranges from 13 to 65 years. The main presenting symptoms were discharge (100%), pruritis ani (60%), pain (23.3%), swelling (16.6%) ,diarrhoea (6.6%) ,constipation (6.6%) and fever (3.3%) .
Fistulogram was accurate to demarcate the fistulous tract in 23 patients (76.6%), and most of our patients were managed under spinal or caudal block anesthesia. 15 patients were treated by fistulectomy operation (group I), the other 15 patients (50%) were treated by cutting seton (group II).
Inspite of slight increase in pain amplitude, and increased discharge in seton group, but the period of hospital stay was less (3 days with seton versus 7 days for fistulectomy), and the mean time needed for healing was also reduced (1.5 months for seton versus 3 months for fistulectomy). Moreover, recurrence was encountered in only 2 cases after seton versus 3 cases after fistulectomy. However the incidence of mild loss of sphincteric control was more after seton group (8 cases versus 6 cases after fistulectomy). Fortunately most of them were slight incontinence to flatus.
These results confirm a world wide observation that seton techniques are successful in treatment of fistula and it still has its role in treatment.