The Effect of Fistulectomy with Seton in Intersphincteric Fistula

Lim, Seok Won; Lee, Chul Ho; Lee, Kwang Real; Yoo, Chung Joon; Park, Se Young; Kim, Hyun Shig; Lee, Jong Kyun

Abstract

Intersphincteric fistulas are the most prevalent fistulas encountered by a surgeon. In general, there are two surgical methods for treating intersphincteric fistulas: fistulotomy and fistulectomy. The advantage of a fistulotomy is less sphincter muscle destruction; the disadvantage is a higher recurrence rate. The advantage of a fistulectomy is a lower recurrence rate; the disadvantage is more sphincter muscle destruction and a higher flatus incontinence rate. Because of the disadvantages with both surgical methods, the authors have developed a new method for treating intersphincteric fistulas. The new method is a fistulectomy with seton. A fistulectomy with seton is a seton tightening of the remaining internal sphincter and subcutaneous external sphincter after coring out of the fistula tract. The advantages of this method are a lower recurrence rate due to complete removal of the fistula and a lower flatus incontinence rate due to the seton slowly cutting the remaining sphincter muscle. For that reason, the authors submit that fistulectomy with seton is the most effective operation method for treating intersphincteric fistulas, especially because fistulectomy with seton has many advantages such as a lower recurrence rate, a lower flatus incontinence rate, and less anal deformity.