MODIFIED SETON TREATMENT OF COMPLEX AND HIGH FISTULA IN ANO - OUR EXPERIENCE

Aim :  Low Anal fistula is treated by either fistulotomy or fistulectomy. However, the treatment of high and complex fistula in not well defined. The patient usually undergoes tailor made procedure from fistulectomy, seton insertion, colonic diversion, mucosal advancement flap procedure to the newer modalities like fibrin glue or fistula plug. Each procedure has some merits and demerits. We describe the use of Multiple Prolene Setons in cases of high and recurrent fistula. Materials and Methods : From January 2001-to April 2017, 46 consecutive patients with high or recurrent anal fistulae were treated using Multiple Prolene Setons (MPS). All patients had three setons inserted through each fistulous tract under GA or spinal anesthesia. One seton was tied to work as cutting seton remaining two left loose to work as drainage seton. These setons were further tied sequentially later. After about 6-8 weeks from insertion of setons, fistulectomy was performed when high/complex fistulae were converted to Low fistula. Results : Total n=46 patients had been submitted for MPS treatment. The median age of patients was 41 (Range was 18-70). Of the 46 patients, 36 patients had primary high fistula, while 10 had recurrent fistula. All thirty six (n=36) patients with primary high fistula had complete healing of the fistulous tract in 8-12 weeks. Of 10 patients with recurrent fistula, seven healed completely in 12 weeks. Three patients had recurrence and were successfully treated again by MPS alone in two while other required diversion colostomy with insertion of MPS.  No patient developed fecal incontinence. Nearly all the patients were satisfied with treatment.  Follow up 100% with a period of 24-156 weeks. Conclusion :  Multiple Prolene Seton (MPS) method is safe, economical and effective in the treatment of high and complex type of fistula in ano. Seton cuts not only from above down but also from lateral to medial, thus converting high fistula to simple fistula. It does not cause fecal incontinence, has good cure rate and most patients were satisfied with the treatment.