Loose Seton Technique in the Management of Complex High Anal Fistula: Enhancing Outcomes with Magnetic Resonance Imaging

Abstract

Background: Complex high anal fistulas challenge treatment efforts, necessitating innovative approaches that balance healing with sphincter preservation. Methods and Results: In a prospective study at Tikrit Teaching Hospital, 39 patients with complex high anal fistulas underwent treatment with loose silicone setons, guided by preoperative MRI mapping. The efficacy of this method was evaluated through follow-up visits at 1, 3, and 6 months, focusing on fistula healing, recurrence rates, continence preservation (assessed by the Wexner Continence Score), and patient satisfaction. Complete healing was achieved in 31 patients (79.5%), with a recurrence rate of 7.7%. There was a significant improvement in continence, with the mean Wexner score reducing from 3.5 to 1.2 (P<0.001). Moreover, 85% of patients expressed satisfaction with their treatment outcomes. Conclusion: The combined use of loose silicone setons and MRI mapping presents an effective, satisfactory method for managing complex high anal fistulas. This technique ensures high healing rates, significantly preserves sphincter function, and achieves high patient satisfaction.

Keywords

• fistula healing
• sphincter preservation
• mri
• patient satisfaction