Abstract
We assessed long-term (greater than 2 years) results of Seton drainage on anal fistulas in patients with Crohn's disease. Methods: Between September 1990 and September 1999, 32 patients with Crohn's disease underwent Seton drainage for complex anal fistulas. Median follow-up was 62 months (range: 25-133 months). In 10 patients (31.3%), recurrent perineal abscesses occurred with inlying Seton dainage, and these were drained by reinsertion of the Seton device. A Malecot catheter was also inserted in 8 patients with recurrence. Results: The overall sucess of long-term Seton usage was 87.5%. The subsequent associated procedure was simple Seton removal (n=9), secondary core-out fistulectomy (n=7), or lay-open fistulotomy (n=4). Eleven patients still had the Seton in place. Recurrence developed in 3 patients (33%) who underwent simple Seton removal and in 2 (18.2%) who underwent secondary core-out or fistulotomy. At the last follow-up examination, continence had not changed in 28 (87.5%) of the 32. No change in continence was experienced by 10 of the 11 who underwent secondary fistulotomy or core-out. Conclusions: Long-term Seton drainage for complex anal fistula in Crohn's disease is efficacious both in treating sepsis and preserving anal sphincter function. A relatively good result was was achieved by secondary core-out or fistulotomy at Seton removal.
