Anal Fistula...
Q. How is Seton[Thread] treatment
done and what are disadvantages of this procedure?
A seton or thread is a loop of flexible material which is placed
along the fistula track to maintain drainage for a period of time. It create
scar tissue around part of the sphincter muscle before it is cut with a knife
TYPES OF SETON
·
Loose seton- In this method, the seton is placed to
maintain drainage and create scar tissue around the sphincter so that it’s
edges don’t retract after cutting.
·
Cutting seton- In this method, the seton is tightened
gradually over regular intervals so that it slowly cut all the way through the
muscle over the course of several weeks .
ADVANTAGES
·
Less-invasive- The procedure involves less cutting
though the final scarring is comparable
to Fistulotomy.
·
Less pain- The pain in this procedure is less
compared to Fistulotomy.
·
Combined with other procedures- In complex fistulas ,this procedure can
be combined with other procedures
DISADVANTAGES
·
Long follow up-The patient need to come for repeated
follow-up visits especially in cutting variety.
·
High risk of Incontinence in
-Anterior fistulas in female patients with a history of vaginal delivery
-High
trans-sphincteric and complex fistulas [ 30-50% incidence of incontinence
to flatus or liquid by seton usage in complex fistulas- Joy et al- Colorectal
Dis. 2002]
A
seton in the fistula
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