The Use of Setons in Fistula-in-Ano

Setons in the treatment of fistula-in-ano have been used for thousands of years. Although there are few high-quality prospective trials, there are numerous retrospective series documenting high cure rates of more than 90% with cutting setons or two stage seton fistulotomy. Both techniques, however, result in a variable rate of incontinence, higher with two stage seton fistulotomy where the internal anal sphincter is routinely divided. Incontinence rates for slow cutting setons are 10%-20% for minor incontinence with rates of 0%-10% for major incontinence; compared to rates of more than 35% and as high as 70% with the two-stage technique. Loose draining setons have an important role the management of Crohn's disease and can result in good palliation with minimal risk of deterioration of bowel control.