EP1085 - Cutting Setons: A Single Center Experience

Purpose/Background: Fistula-in-ano is an abnormal tract connecting the anal canal to the perianal skin, typically resulting from chronic infections or commonly inflammatory bowel disease. Management is challenging, requiring eradication of the fistulous tract while preserving fecal continence. Current recommendations support cutting seton use in more complex fistula-in-ano cases, though this intervention is utilized infrequently in practice, likely due to limited evidence regarding their efficacy.2Few studies regarding outcomes for cutting setons have been conducted but evidence is promising, demonstrating higher rates of healing and lower recurrence rates. This study aims to report a single institution’s healing, recurrence, and incontinence outcomes for cutting seton fistulotomy.

Methods/Interventions: We identified 36 patients who obtained cutting setons for fistula-in-ano at Jefferson between 2012-2025. Of these patients, 23 patients had follow-up information from which to extract healing, recurrence, and incontinence data. We also identified 154 patients who received fistulotomy and/or noncutting seton placement to calculate recurrence, healing, and incontinence rates for comparison. A competing risk analysis was used for recurrence and healing rates. We defined healing as documented healing of 85% or greater.

Results/Outcomes: In our cohort of 23 patients, 14 were male with a majority being white (10). 17 of these 23 got cutting setons as the first procedure, whereas six patients were being treated with a cutting seton after previously receiving a fistulotomy and/or noncutting seton placement. In our group of patients treated with fistulotomy and/or noncutting seton, 75.3% (CI 66.8-81.8%) had almost complete healing and only 7.8% (CI 3.9-13.3%) recurrence at 3 years post-op. In contrast, in our cutting seton cohort 86.5% (CI 45.6-97.4%) had almost complete healing and 5.8% (CI 0.3-24.7%) recurrence at 3 years post-op. Eight patients in the fistulotomy and/or noncutting seton group had incontinence, whereas no patients in the cutting seton cohort demonstrated incontinence.

Conclusion/Discussion: In conclusion, our cohort of cutting seton patients demonstrates comparable rates of healing, recurrence, and incontinence at our institution when compared to our cohort of fistulotomy patients with or without noncutting setons. Although our cohort is too small for statistical significance, these trends suggest that cutting seton is a safe and viable option for treating fistula-in-ano. We plan on administering an incontinence survey to these patients to better assess any possible incontinence in this cohort.