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

There are two main complications after surgery of complex fistula-in-ano: i.e. faecal incontinence and recurrence. 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