VM51 - Trans-intersphincteric Double Seton for Perianal Abscess

Purpose/Background: The patient was a 27-year-old male
Main Complaint: Perianal swelling and pain were observed for 4 days.
Anal examination (knee-chest position): there was a red mass about 2*3cm in size at the 5 o 'clock position of the anus 3cm from the anal verge.
MRI showed that the abscess was located in the ischiorectal fossa.
Other laboratory tests: no abnormality.

Methods/Interventions: Perianal abscess has long been a subject of research aiming to balance the cure rate and fecal incontinence. The setons were placed from intersphincteric incision to the different direction, which ensured proper drainage and protected all the anal sphincter.
Preparation: Clean enema
Anesthesia: Spinal anesthesia
Position: Lateral position
Technique:
1. Intersphincteric incision was made between the internal and external sphincter.
2. The internal and external sphincter muscles were gradually separated until reaching the internal opening.
3. The drainage incision was made at the site of the abscess, which avoided damaging the external sphincter.
4. The first seton was inserted between the drainage incision and the intersphincteric incision.
5. The second seton was placed between the the intersphincteric incision and internal opening .

Results/Outcomes: The operation was completed. The postoperative management is as follows:
1.Patient can eat and drink normally 6 hours after surgery.
2. Treatment with antibiotics for 3 days.
3. Sitz bath and dressing change once a day.
4.Keeping the stools soft, the area clean, and pain tolerable.
The patient discharged 3 days after operation and recovered well. During the follow-up three months after the operation, There was complete healing of the incision with no discomfort.

Conclusion/Discussion: Trans-intersphincteric Double Seton has a positive role to play in the management of perianal abscess, as it not oniy carries a good outcome of the cure rate, but also protects the anal sphincter.