Long-term seton drainage for high anal fistulas in Crohn's disease—A sphincter-saving operation?

TLDR

Forty‑one Crohn’s disease patients underwent long‑term seton drainage for high anal fistulas, followed by simple seton removal (18), secondary fistulotomy (7), rectal flap advancement (3), or proctectomy (2). Recurrence developed in 39 % of patients after simple seton removal and in one case after rectal flap advancement, but none after secondary fistulotomy; 12 % required proctectomy for severe proctitis and 12 % developed anal incontinence, severe in two, demonstrating that long‑term seton drainage effectively controls sepsis while preserving sphincter function.

Abstract

METHODS: Forty-one consecutive patients with Crohn's disease who underwent long-term seton drainage for high transsphincteric, suprasphincteric, or extrasphincteric anal fistula from 1985 to 1993 were reviewed. The subsequent associated procedure was simple seton removal (18), secondary fistulotomy (7), rectal flap advancement (3), and proctectomy (2). Eleven patients still had the seton in place. RESULTS: Recurrence developed in seven patients (39 percent) undergoing simple seton removal and in one patient undergoing rectal flap advancement. None of the patients treated by secondary fistulotomy developed a recurrence. At the end of follow-up, five patients (12 percent) required proctectomy mainly for severe proctitis, and five patients (12 percent) developed anal incontinence, which was severe in two. CONCLUSION: Long-term seton drainage for high anal fistula in Crohn's disease is efficacious in both treating sepsis and preserving anal sphincter function.