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Journal of Integrative Medicine ›› 2016, Vol. 14 ›› Issue (2): 154-158.doi: 10.1016/S2095-4964(16)60229-7

• Short Report • Previous Articles    

Management of low transsphincteric anal fistula with serial setons and interval muscle-cutting fistulotomy

ChenWanga,b, LesterRosena   

  1. a Department of Colorectal Surgery, Cleveland Clinic Florida, Weston, FL 33331, USA
    b Department of Anorectal Surgery, Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai 200032, China
  • Received:2015-06-10 Accepted:2015-09-25 Online:2016-03-15 Published:2016-03-15
  • Contact: Prof. Lester Rosen; E-mail:

This study evaluates low transsphincteric anal fistula managed by serial setons and interval fistulotomy, with attention to healing without recurrence and preservation of continence. Following Institutional Review Board approval, consecutive anal fistula operations performed by a single surgeon from January 1, 2009 to December 31, 2013 were retrospectively reviewed using electronic medical records and telephone interviews for patients lost to follow up. Of the 71 patients, 26 (37%) had low transsphincteric fistula (23 males and 3 females; mean age: 46 years), treated at our institution by seton placement followed by interval surgical muscle cutting and subsequent seton replacement or final fistulotomy. Of the 26 patients, 22 (85%) were initially referred due to previous failed treatment, with a 30.6 month mean duration of fistula prior to referral and a mean of 2.2 (range: 0-6) prior anorectal surgeries. At a mean follow-up of 11.9 months, none of the 21 patients experienced recurrence or fecal incontinence. Serial seton with interval muscle-cutting sphincterotomy followed by complete fistulotomy is an effective treatment for the management of patients who are either initially seen for low transsphincteric fistula, or referred after failed anorectal surgery for that condition.

Key words: Low transshpincteric fistula, Serial seton, Fistulotomy, Recurrent fistula, Fecal incontinence

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