Lower Fistula Recurrence with Pulling Seton: A Retrospective Cohort Study

Background: Anal fistulas are one of the interactable cases in proctologic clinics. Managing these patients has the major risk of recurrence and incontinence. Objectives: In this retrospective cohort study, we compared the results of three sphincter saving procedures during a two-year follow-up phase. Methods: A total of 87 patients who underwent endorectal advancement flap, cutting Seton, and pulling Seton surgeries were followed for two years from 2017 to 2018 in a tertiary proctologic referral center affiliated to Shiraz University of Medical Sciences, Iran. The recurrence rate and Wexner score were compared between the groups. Results: The lowest recurrence rate was 13.8% with pulling Seton technique, and the highest recurrence rate was 42.9% with endorectal advancement flap (P = 0.04). The mean Wexner score did not significantly change before and after the surgery. Conclusions: According to our results, pulling Seton seems to be a safe method for treatment of anal fistulas. This technique had a low recurrence rate, and the patients’ continence was not damaged.