الفهرس 
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Abstract
SUMMARY
This study aims to evaluate the rate of recurrence of high anal fistula after using cutting seton suture method in repair of high anal fistula.
For many years anal fistula has been a surgical problem in view of the high number of postoperative complications such as incontinence of gases and faeces and recurrent course of the disease.
This study represents a prospective case series study review of 20 patients, with 12 males and 8 females, who were treated for an anal fistula with or without an ischiorectal abscess from April 2020 until March 2021 for a duration up to one year. . Perianal area was inspected, which revealed the external opening, all patient are reviewed carefully for assessment of rate of recurrence of high perianal fistula after seton suture.
Ethical consideration were followed in taking informed consent from every patient with respect for anonymity, confidentiality, and benefit for them and respecting for their privacy.
A rectal wash was done 24 h before the surgery with small dose laxatives and rectal enemas.
The procedure was carried out under anesthesia in lithotomy position. Before proceeding for surgery, methylene blue was injected through the external opening to localize the internal opening.
The procedure involved running a surgical-grade cord through the fistula tract so that the cord creates a loop that joined up outside the fistula. The cord provides a path that allows the fistula to drain continuously while it is healing, rather than allowing the exterior of the wound to close over. Keeping the fistula tract open can help prevent the trapping of pus or other infectious material in the wound.
Cutting seton method was used, Suitable length of non-absorbable suture was introduced through the probe and other end brought out of the anus.
The Probe was introduced through the external opening and the fistulous tract cored up to the external sphincter and the remaining tract and brought out through the internal opening and anus. Then curettage was performed.
The patient was discharged on the second postoperative day and advised to pull on the seton daily as tolerated. Repeated examinations were carried out at 1–2 weeks interval.
At each visit, the position of seton was assessed. The seton gradually cut through the fistulous tract within 4–10 weeks. The patients were followed-up for one year to see the wound healing and development of any complications such as recurrence or incontinence.
Finally total of 20 patient only 3 patients suffered from recurrence of anal fistula with percentage of 15% and 3 patients underwent abscess formation after 3 months of treatment and needs another surgical intervention.
Two of recurrent case were suffering from diabetes mellitus uncontrolled on insulin chart and hypertension. The other one suffer from hypertension with bad hygiene.
Totally 3 patients needs another surgical intervention with percentage of 15% of all studied cases, with good healing percentage for other cases within 3-6 months according to pain, incontinence abscess formation, time of healing and recurrence.