An alternative to the use of seton's that we have been using in the practice for several years is fibrin glue. This situation occurs when the fistula tract involves an amount of sphincter muscle that can't be simply divided by fistulotomy, without adverse consequences. The fistula tract is initially scrapped to allow the glue to become adherent to the wall. The "glue" is then injected into the tunnel and the internal opening is closed. Your body then incorporates the glue and seals the tunnel off. The benefit is that no sphincter is divided (therefore no risk of control problems). The downside is the success rate is only about 50%. This is performed as an outpatient procedure under local anesthesia with intravenous sedation.
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