Abstract
Fistula-in-ano is a challenging problem where treatment attempts have been traced back to the days of Hippocrates and even earlier. Surgical treatment of fistula-in-ano is dictated by the amount of sphincter involved and internal and external anal sphincters preservation is in the interest of continence maintenance. There are a variety of reasons to use setons in the management of anal fistulas. They consent to drain the track preparatory to an attempted repair (bridge to sphincter preserving techniques), as a way of staging fistulotomy, or to set the stage for spontaneous healing. Although many advocate that loose seton placement should be the gold standard in the management of complex fistula, existing literature results often consist of small/medium volume case series with limited follow-up and conflicting results when compared to other techniques, still leaving to the surgeon the choice of the best treatment based on personal experience and patients’ characteristics.
However, despite the heterogeneity of the studies on this topic, the variability of the results and their methodology usually retrospective and with short follow-up remains the impression that although the seton is an ancient treatment, its role in fistula management is still predominant and can be further explored.
Similar content being viewed by others
References
Abcarian H (2011) Anorectal infection: abscess-fistula. Clin Colon Rectal Surg 24:14–21
Abdelnaby M, Emile S, El-Said M, Abdallah E, AbdelMawla A (2019) Drained mucosal advancement flap versus rerouting seton around the internal anal sphincter in treatment of high trans-sphincteric anal fistula: a randomized trial. Int J Surg 72:198–203
Akici M, Ersen O (2020) The effect of suture selection in complex anal fistulas on the success of cutting seton placement and patient comfort. Pak J Med Sci 36:816–820
Amato A, Bottini C, De Nardi P, Giamundo P, Lauretta A, Realis Luc A, Piloni V (2020) Evaluation and management of perianal abscess and anal fistula: SICCR position statement. Tech Coloproctol 24:127–143
Blumetti J, Abcarian A, Quinteros F, Chaudhry V, Prasad L, Abcarian H (2012) Evolution of treatment of fistula in ano. World J Surg 36:2162–2167
Bolshinsky V, Church J (2018) How to insert a draining seton correctly. Dis Colon Rectum 61:1121–1123
Buchanan GN, Owen HA, Torkington J, Lunniss PJ, Nicholls RJ, Cohen CR (2004) Long-term outcome following loose-seton technique for external sphincter preservation in complex anal fistula. Br J Surg 91:476–480
Daodu OO, O’Keefe J, Heine JA (2018) Draining setons as definitive management of fistula-in-ano. Dis Colon Rectum 61:499–503
de Groof EJ, Cabral VN, Buskens CJ, Morton DG, Hahnloser D, Bemelman WA, Research Committee of the European Society of Coloproctology (2016) Systematic review of evidence and consensus on perianal fistula: an analysis of national and international guidelines. Colorectal Dis 18:O119–O134
Eitan A, Koliada M, Bickel A (2009) The use of the loose seton technique as a definitive treatment for recurrent and persistent high trans-sphincteric anal fistulas: a long-term outcome. J Gastrointest Surg 13:1116–1119
Emile SH, Elfeki H, Thabet W, Sakr A, Magdy A, El-Hamed TMA, Omar W, Khafagy W (2017) Predictive factors for recurrence of high transsphincteric anal fistula after placement of seton. J Surg Res 213:261–268
García-Aguilar J, Belmonte C, Wong DW, Goldberg SM, Madoff RD (1998) Cutting seton versus two-stage seton fistulotomy in the surgical management of high anal fistula. Br J Surg 85:243–245
Ho KS, Tsang C, Seow-Choen F et al (2001) Prospective randomised trial comparing ayurvedic cutting seton and fistulotomy for low fistula-in-ano. Tech Coloproctol 5:137–141
Kelly ME, Heneghan HM, McDermott FD et al (2014) The role of loose seton in the management of anal fistula: a multicenter study of 200 patients. Tech Coloproctol 18:915–919
Lim CH, Shin HK, Kang WH et al (2012) The use of a staged drainage seton for the treatment of anal fistulae or fistulous abscesses. J Korean Soc Coloproctol 28:309–314
Maksimovic J, Maksimovic M (2013) From history of proctology. Arch Oncol 21:28–33
Omar W, Alqasaby A, Abdelnaby M, Youssef M, Shalaby M, Anwar Abdel-Razik M, Emile SH (2019) Drainage seton versus external anal sphincter-sparing seton after rerouting of the fistula tract in the treatment of complex anal fistula: a randomized controlled trial. Dis Colon Rectum 62:980–987
Ommer A, Herold A, Berg E, Fürst A, Post S, Ruppert R, Schiedeck T, Schwandner O, Strittmatter B (2017) German S3 guidelines: anal abscess and fistula (second revised version). Langenbeck’s Arch Surg 402:191–201
Pinedo MG, Caselli MG, Urrejola SG et al (2010) Modified loose-seton technique for the treatment of complex anal fistulas. Color Dis 12:e310–e313
Ratto C, Grossi U, Litta F, Di Tanna GL, Parello A, De Simone V, Tozer P, DE Zimmerman D, Maeda Y (2019) Contemporary surgical practice in the management of anal fistula: results from an international survey. Tech Coloproctol 23:729–741
Shanwani A, Nor AM, Amri N (2010) Ligation of the intersphincteric fistula tract (LIFT): a sphincter-saving technique for fistula-in-ano. Dis Colon Rectum 53:39–42
Subhas G, Gupta A, Balaraman S, Mittal VK, Pearlman R (2011) Non-cutting setons for progressive migration of complex fistula tracts: a new spin on an old technique. Int J Color Dis 26:793–798
Subhas G, Singh Bhullar J, Al-Omari A, Unawane A, Mittal VK, Pearlman R (2012) Setons in the treatment of anal fistula: review of variations in materials and techniques. Dig Surg 29:292–300
Tan KK, Tan IJ, Lim FS, Koh DC, Tsang CB (2011) The anatomy of failures following the ligation of intersphincteric tract technique for anal fistula: a review of 93 patients over 4 years. Dis Colon Rectum 54:1368–1372
Tan KK, Alsuwaigh R, Tan AM, Tan IJ, Liu X, Koh DC, Tsang CB (2012) To LIFT or to flap? Which surgery to perform following seton insertion for high anal fistula? Dis Colon Rectum 55:1273–1277
Verkade C, Zimmerman DDE, Wasowicz DK, Polle SW, de Vries HS (2020) Loss of seton in patients with complex anal fistula: a retrospective comparison of conventional knotted loose seton and knot-free seton [published online ahead of print, 2020 Jun 19]. Tech Coloproctol. https://doi.org/10.1007/s10151-020-02254-1
Vogel JD, Johnson EK, Morris AM, Paquette IM, Saclarides TJ, Feingold DL, Steele SR (2016) Clinical practice guideline for the management of anorectal abscess, fistula-in-ano, and rectovaginal fistula. Dis Colon Rectum 59:1117–1133
Williams G, Williams A, Tozer P, Phillips R, Ahmad A, Jayne D, Maxwell-Armstrong C (2018) The treatment of anal fistula: second ACPGBI Position Statement – 2018. Color Dis 20(Suppl 3):5–31
Yamana T (2018) Japanese practice guidelines for anal disorders II. Anal fistula. J Anus Rectum Colon 2:103–109
Author information
Authors and Affiliations
Editor information
Editors and Affiliations
Section Editor information
Rights and permissions
Copyright information
© 2021 Springer Nature Switzerland AG
About this entry
Cite this entry
Martellucci, J., Vuolo, M.L. (2021). The Seton in Anal Fistula Management. In: Ratto, C., Parello, A., Litta, F., De Simone, V., Campennì, P. (eds) Anal Fistula and Abscess. Coloproctology. Springer, Cham. https://doi.org/10.1007/978-3-030-30902-2_18-1
Download citation
DOI: https://doi.org/10.1007/978-3-030-30902-2_18-1
Received:
Accepted:
Published:
Publisher Name: Springer, Cham
Print ISBN: 978-3-030-30902-2
Online ISBN: 978-3-030-30902-2
eBook Packages: Springer Reference MedicineReference Module Medicine