Outcomes of Loose Seton Followed by Fistulotomy in Transsphincteric Perianal Fistulas: A Retrospective Study

Abstract

Aim: This retrospective study aimed to investigate the outcomes of the “loose seton followed by fistulotomy” technique in patients with transsphincteric perianal fistulas, focusing on the effectiveness of this surgical technique in achieving fistula tract healing while preserving anal sphincter function. Method: A total of 114 patients with transsphincteric anal fistulas underwent surgery at the University of Health Sciences Turkey, Samsun Training and Research Hospital between September 2015 and December 2023. The technique of loose seton followed by fistulotomy was employed, and patient data, including demographics, surgical procedures, incontinence scores, complications, and recurrence rates, were collected and analyzed using statistical methods. Results: During a median follow-up period of 27.8 weeks, complete healing of the fistula was observed in all patients (100%), with no cases of seton loss or recurrence observed in five patients (4.8%). The median incontinence scores post last operation and at present were significantly improved compared with preoperative scores. The overall incontinence rate postoperatively was found to be 1.8%. Conclusion: The loose seton followed by fistulotomy technique demonstrated favorable outcomes in terms of fistula healing, low rates of incontinence, and acceptable recurrence rates. Despite the need for multiple surgeries in some cases, the benefits of this approach in preserving continence and reducing recurrence support its suitability for treating transsphincteric perianal fistulas.

Keywords

• perianal fistula
• loose seton
• fistulotomy
• transsphincteric fistula
• incontinence