TITLE:
Loose Seton: A Misnomer of Cutting Seton
AUTHORS:
Ugur Sungurtekin, Murat Ozban, Halil Erbis, Onur Birsen
KEYWORDS:
Perianal Fistula, Seton, Incontinance, Recurrence
JOURNAL NAME:
Surgical Science,
Vol.7 No.5,
May
11,
2016
ABSTRACT: Purpose: The purpose of this study was to demonstrate loose silk seton
actually acts as a slow cutting seton contrary to the idea of simply drainage.
Besides, to show the effect of loose seton on patient’s incontinence is mostly
proportional to the degree of division of the sphincter muscle. Design: Fifty
patients with high transsphincteric fistulas were treated with loose seton
technique. We measured the length of high sphincteric fistula tracts, pre- and
postoperative anal sphincter pressures and incontinence scores. Results: Loose
seton with heavy silk resulted in 72% percent of progressive migration of the
fistula tract caudally. The more the progressive migration of the loose seton
loop, the less the pressure drop in both resting and squeezing in manometric
studies. This study is limited by its retrospective design in prospectively
collected data and covers relatively small number of patients. Conclusion:
Seton is still useful technique in high perianal fistula surgery. Defining this
technique as simply “loose” seton is misnomer since it acts as a slowly cutting
seton and results in progressive migration of the fistula tract caudally. The
more the progressive migration of the loose seton loop, the less the pressure
drop would be possible after postoperatively.