FISTULECTOMY VERSUS SETON PLACEMENT IN FISTULA-IN-ANO: A PROSPECTIVE COMPARATIVE STUDY FROM A TERTIARY CARE CENTER IN NORTH INDIA
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Keywords
Fistula-in-ano; Fistulectomy; Seton placement; Anal fistula; Surgical outcomes; Continence
Abstract
Fistula-in-ano is a common anorectal disorder arising most frequently from cryptoglandular infection. Surgical management aims to eradicate the fistulous tract while preserving anal sphincter function and continence. Fistulectomy and seton placement are widely practiced procedures, yet there remains no consensus regarding their relative advantages.
Aim: To compare the outcomes of fistulectomy and seton placement in the management of fistula-in-ano.
Materials and Methods: This prospective comparative study was conducted over six months in the Department of General Surgery at a tertiary care hospital in North India. A total of 80 patients diagnosed with fistula-in-ano were enrolled and allocated into two groups: Group A (fistulectomy, n=40) and Group B (seton placement, n=40). Patients aged 18–65 years with low or high fistulae were included, while those with recurrent fistulae, Crohn’s disease, tuberculosis, malignancy, or pre-existing incontinence were excluded. Outcomes assessed included operative time, postoperative pain (VAS score), wound healing time, postoperative complications, recurrence, and continence status. Statistical analysis was performed using appropriate parametric and non-parametric tests, with a p-value <0.05 considered significant.
Results: Both groups were comparable in terms of age, sex distribution, and fistula type. The mean operative time was significantly shorter in the seton group (p<0.001). Postoperative pain scores were significantly lower in patients undergoing seton placement (p=0.02). Wound healing occurred earlier in the fistulectomy group (p=0.01). Transient fecal incontinence was significantly more frequent following fistulectomy (p=0.04), while seton placement demonstrated better sphincter preservation. Recurrence rates at six months were low and comparable between the two groups (p=0.69).
Conclusion: Both fistulectomy and seton placement are effective treatment modalities for fistula-in-ano. Fistulectomy results in faster wound healing, whereas seton placement offers better postoperative comfort and continence preservation. Surgical management should be individualized based on fistula characteristics and sphincter involvement.
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Dr Sachin Choudhary
Assistant Professor, Department of General Surgery, Army College of Medical Sciences, New Delhi, India.
Dr Megha Saxena
Senior Resident, Breast and Endocrine Surgery, Sanjay Gandhi Post Graduate Institute, Lucknow, Uttar Pradesh, India.
Dr Vikas Arora
Assistant Professor, Department of Forensic Medicine and Toxicology, Teerthankar Mahaveer
Dr Jatin Prajapati
Senior Resident, Department of Community Medicine, World College of Medical Sciences and Research, Jhajjar, Haryana, India. (ORCID: https://orcid.org/0009-0004-7298-4499 )
