The anorectal fistula is a disease requiring careful assessment of the local signs and precise localization of the fistula channel. The Seton procedure for treatment of the fistula-in-ano we apply only for the management of trans- or extrasphincteric anorectal fistula. 152 patients with high trans- or extrasphincteric fistula-in-ano were operated. Men were 123/80.92%/, women-29/19.08%/. In 70 /46.05%/ fistula were extrasphincteric, while in 82/53.95%/ they were transsphincteric. Ba sic step is to identify the internal opening of the fistula channel following Goodsal`s rule. The Seton is trespassed through the internal opening and we tight it moderately. Every next tightening is performed at 3 days intervals. Recurrences ware registered in the first 6 months in 8 patients/5.26%/. We conclude that that seton procedure for treatment of trans- and extrasphincteric fistula is an easy to learn and practice radical one stage surgical method with a cure rate of nearly 95%. Elastic Seton ligation technique is a modification of the known from ancient times conventional ligation procedure. The following procedure is an effective method for difficult and high fistula-in-ano.
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