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Comparative Study
. 2025 Aug 25;40(1):187.
doi: 10.1007/s00384-025-04985-9.

Influence of seton configuration, thickness, and laxity on patient comfort in chronic perianal fistula: a prospective comparative study

J Barambio  1 , Ana Leon-Bretscher  2   3 , María Ramírez Bescos  1 , Paula Soto García  1 , Paloma Gadea Uria  1 , Teresa Laloumet Garcimartin  1 , Elena Viejo Martinez  1 , Felipe Acedo Fernandez de Pedro  1 , Patricia Ortega Domene  1 , Alicia Ruiz de la Hermosa  1 , María Luisa De Fuenmayor-Valera  1 , Gloria Paseiro-Crespo  1   4
Affiliations
Comparative Study

Influence of seton configuration, thickness, and laxity on patient comfort in chronic perianal fistula: a prospective comparative study

J Barambio et al. Int J Colorectal Dis. .

Abstract

Purpose: To determine how seton configuration, thickness, and laxity influence patient comfort and clinical outcomes in the management of chronic perianal fistulas.

Methods: A prospective single-center study was conducted involving 33 patients (53 setons). Both intraindividual paired (n = 20) and independent group analyses (n = 13) were performed. Setons were categorized by configuration (O-shaped vs. V-shaped), thickness (1.5 mm vs. 2.5 mm), and laxity (≤ 2 cm vs. > 2 cm from the anal verge). Patient-reported outcomes were assessed using structured questionnaires evaluating sitting discomfort, discharge, sexual impact, and fecal incontinence.

Results: O-shaped setons caused significantly less sitting discomfort than V-shaped ones (50.0% vs. 80.0%, p = 0.021). Excess laxity (> 2 cm) was associated with increased discharge (86.4% vs. 51.6%, p = 0.008), sexual impact (42.1% vs. 10.3%, p = 0.016), and fecal incontinence (66.7% vs. 10.0%, p = 0.041). Thicker setons (2.5 mm) showed a non-significant trend toward more pain (42.9% vs. 17.9%, p = 0.080).

Conclusion: Seton configuration and laxity significantly affect patient comfort. O-shaped setons and shorter laxity (≤ 2 cm) are preferable for reducing discomfort. These findings support evidence-based seton selection, although larger multicenter studies are needed to confirm these results.

Keywords: Laxity; O-shaped seton; Perianal fistula; Quality of life; Seton drainage; Seton thickness; Silicone vessel loop; Surgical techniques; V-shaped seton.

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Conflict of interest statement

Declarations. Financial Disclosures: All authors declare no financial relationships relevant to this study.All authors declare no financial relationships relevant to this study. Data Sharing Statement: The data that support the findings of this study are available from the corresponding author upon reasonable request. Access to de-identified patient data will be granted to researchers with a methodologically sound proposal, following institutional and ethical guidelines. Requests should be directed to analeonbre@gmail.com. Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Schematic representation of the two seton configurations used in the study. (A). (A) O-shaped configuration, with the silicone loop tied upon itself, allowing rotational movement. (B) V-shaped configuration, with both ends aligned and directed externally, limiting mobility
See this image and copyright information in PMC

References

    1. Jimenez M, Mandava N (2025) Anorectal fistula. In: StatPearls. StatPearls Publishing, Treasure Island (FL) - PubMed
    1. Feroz SH, Ahmed A, Muralidharan A, Thirunavukarasu P (2020) Comparison of the efficacy of the various treatment modalities in the management of perianal crohn’s fistula: a review. Cureus 12(12):e11882 - PMC - PubMed
    1. Shawki S, Wexner SD (2011) Idiopathic fistula-in-ano. World J Gastroenterol 17(28):3277–3285 - PMC - PubMed
    1. Sterzing D (2024) On fistulas and threads : sense and nonsense of seton drainage. Chirurgie (Heidelb) 95(3):221–228 - PubMed
    1. Saigusa N, Saigusa JI, Shinozaki M, Yokoyama T, Yokoi Y, Takami H et al (2018) A series of seton techniques involving “top-down therapy” for patients with Crohn’s disease who initially presented with perianal fistulas. J Anus Rectum Colon 2(4):122–129 - PMC - PubMed

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