Outcome of Surgery for the Management of High Perianal Fistulae Using Elastic Seton: Elastic Seton Outcomes in High Anal Fistula

Tayyaba Jamil; Muzammal Islam; Mohammad Amir Jan; Abrar Nazir

doi:10.54393/pjhs.v6i9.3471

Authors

Tayyaba Jamil Department of Surgery, Sir Ganga Ram Hospital, Fatima Jinnah Medical University, Lahore, Pakistan
Muzammal Islam Department of Surgery, Sir Ganga Ram Hospital, Fatima Jinnah Medical University, Lahore, Pakistan
Mohammad Amir Jan Department of Surgery, Sir Ganga Ram Hospital, Fatima Jinnah Medical University, Lahore, Pakistan
Abrar Nazir Department of Surgery, Sir Ganga Ram Hospital, Fatima Jinnah Medical University, Lahore, Pakistan

DOI:

https://doi.org/10.54393/pjhs.v6i9.3471

Keywords:

High Perianal Fistulae, Elastic Seton, Fistulectomy, Sphincter Reconstruction

Abstract

High perianal fistulae are complex infections often originating from anal glands, requiring sphincter-preserving surgical approaches. Elastic seton offers controlled tract closure with reduced need for postoperative adjustments compared to traditional cutting setons. Objectives: To evaluate the outcomes of elastic seton in managing high perianal fistulae, focusing on pain, healing, hospital stay, and continence preservation. Methods: This descriptive case series was conducted from February 2025 to May 2025 at the Department of Surgery, Surgical Unit III, Sir Ganga Ram Hospital, Lahore. Forty-five patients with high perianal fistulae were enrolled using consecutive non-probability sampling. An elastic seton from a latex glove was placed under spinal anesthesia. Follow-ups at 1 week, 4 weeks, 3, and 6 months assessed pain (VAS), wound healing, complications, and analgesic use. Data were analyzed with SPSS v24.0 using Chi-square and ANOVA, with p < 0.05 significant. Results: Of the 45 patients (64.4% male; mean age 31.3 ± 8.4 years), the mean symptom duration was 11.8 ± 4.1 weeks, and average seton cut-through time was 6.3 ± 0.9 weeks. VAS scores significantly decreased from 5.13 (Week 1) to 0.40 (6 months) (p < 0.001). Complete wound healing occurred in 82.2% of patients, while complications declined from 42.2% to 17.8%. Conclusion: Elastic cutting seton with staged fistulotomy ensured safe, effective high anal fistula management with reduced pain, rapid healing, and preserved continence.

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