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.