Fistulous tracts about the anus deep to the external sphincter muscle are often associated with such destruction in their vicinity that it is often not anatomically or functionally advisable to cut through the sphincter muscle at the time the fistula is first attacked. The advisability of completely cutting through a fistulous tract in a one-stage operation depends, of course, on the length or depth of the fistula, as well as upon the nature of the surrounding tissue. The unsupported ends of a cut sphincter may likely fall back into recesses of an abscess cavity behind it and even may be held apart permanently as the cavity fills in with new tissue around the sphincter. This may result in partial or total incontinence or a deep trough at the anal verge, which may be difficult to cleanse after a bowel movement. Hence, it may be expedient at times to isolate the
HYMAN C. Use of Braided Wire Seton for Two-Stage Anorectal Fistula Operation: Preliminary Report. AMA Arch Surg. 1955;71(6):890–891. doi:10.1001/archsurg.1955.01270180096013
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