Tightening of seton using Roeder’s knot in Complex Fistula - in - ano : with knot pusher (specially designed)

Objective: There are two main complications after surgery of complex fistula-in-ano: i.e. faecal incontinence and recurrence. Summary Background Data: To prevent incontinence of stools and flatus we require saving the anal sphincter muscle with tightening of seton using Roeder's knot with knot pusher (specially designed). Method: The study includes 40 patients who had undergone treatment of complex and high fistula-in-ano at Civil Hospital, Jalandhar from January, 2010 to September 2012 and from September, 2012 to January, 2014 at Punjab Institute of Medical Sciences (PIMS). Results: 40 patients of complex fistula-in-ano were taken up for study with the age (mean ± standard deviation) of 35 ± 10.6 years. The Roeder's knot was tightened with a median of 5 times (3-10 times) as OPD procedure. All the patients were on follow up for minimum period of 6 months and none of the patient had any incontinence. Recurrence occurred in one case. There was breakage of thread at knot site with knot pusher in two cases. Conclusion: Tightening of seton using Roeder's knot is safe, cost effective treatment for complex fistula-in-ano and follow up is easy and tightening of fistula is an outdoor procedure rather than replacing the loose seton. Fistula-in-ano or recurrent fistula or fistula encircling more than 30% of external anal sphincter. Patients were on follow up every week and seton with Roeder's knot tightened in O.P.D after application of 2% xylocain jelly. Incontinence was assessed according to wexner's score.