{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,13]],"date-time":"2026-08-13T20:40:50Z","timestamp":1786653650824,"version":"build-2736575974"},"reference-count":10,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"1","content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2016,1]]},"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>Seton-based techniques are among popular methods for treating high type anal fistula. These techniques are categorized to cutting and noncutting regarding their mechanism of action. In this report we are about to describe a new technique, which is a combination of both mechanisms; we call it Pulling Seton.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Materials and Methods:<\/jats:title>\n                    <jats:p>In this technique after determining internal and external orifice of fistula, fistulectomy is done from both ends to the level of external sphincteric muscle. Finally, a remnant of fistula, which remains beneath external sphincteric muscle is excised, and Seton is passed instead of it and tied externally. After the wound heals, patient is asked to pull down the Seton for 3\u20134 min, 4 times a day. We prospectively enrolled 201 patients with high type anal fistula in this study.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>Seton gradually passes through external sphincteric muscle till it is displaced outwards or removed by a surgeon via a small incision. 94% of patients treated by this method accomplished their treatment completely without recurrence. None of the patients developed permanent fecal or gas incontinence. Only 5% of patients developed with recurrence of fistula. Since Seton traction is not permanent in this technique, Seton cuts external sphincter slowly, and minimal rate of incontinence is reported.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>Pulling Seton seems to be an efficient way in treating high type anal fistula with minimal rate of recurrence and complications such as incontinence and authors suggest further randomized studies to compare its efficacy with other Seton-based techniques.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.4103\/2277-9175.180637","type":"journal-article","created":{"date-parts":[[2016,4,19]],"date-time":"2016-04-19T02:41:06Z","timestamp":1461033666000},"update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":7,"title":["Pulling Seton: Combination of mechanisms"],"prefix":"10.4103","volume":"5","author":[{"given":"Ahmad","family":"Izadpanah","sequence":"first","affiliation":[{"name":"Department of Surgery, Colorectal Research Center, Shiraz, Iran"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohammad","family":"Rezazadehkermani","sequence":"additional","affiliation":[{"name":"Department of Surgery, Shiraz University of Medical Sciences, Shiraz, Iran"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Seyed Mohammad","family":"Hosseiniasl","sequence":"additional","affiliation":[{"name":"Department of Surgery, Shiraz University of Medical Sciences, Shiraz, Iran"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Afrouz","family":"Farghadin","sequence":"additional","affiliation":[{"name":"Shiraz Blood Transfusion Organization, Shiraz, Iran"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Leila","family":"Ghahramani","sequence":"additional","affiliation":[{"name":"Department of Surgery, Colorectal Research Center, Shiraz, Iran"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alimohammad","family":"Bananzadeh","sequence":"additional","affiliation":[{"name":"Department of Surgery, Colorectal Research Center, Shiraz, Iran"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Reza","family":"Roshanravan","sequence":"additional","affiliation":[{"name":"Department of Surgery, Colorectal Research Center, Shiraz, Iran"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ahad","family":"Izadpanah","sequence":"additional","affiliation":[{"name":"Department of Surgery, Shiraz University of Medical Sciences, Shiraz, Iran"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2016,4,19]]},"reference":[{"key":"R1-20251008","doi-asserted-by":"crossref","first-page":"1465","DOI":"10.1097\/DCR.0b013e31823122b3","article-title":"Standards Practice Task Force of the American Society of Colon and Rectal Surgeons. Practice parameters for the management of perianal abscess and fistula-in-ano","volume":"54","author":"Steele","year":"2011","journal-title":"Dis Colon Rectum"},{"issue":"Suppl 1","key":"R3-20251008","doi-asserted-by":"crossref","first-page":"S15","DOI":"10.1007\/s10151-010-0607-y","article-title":"Perianal fistulas","volume":"14","author":"Michalopoulos","year":"2010","journal-title":"Tech Coloproctol"},{"key":"R4-20251008","doi-asserted-by":"crossref","first-page":"292","DOI":"10.1159\/000342398","article-title":"Setons in the treatment of anal fistula: Review of variations in materials and techniques","volume":"29","author":"Subhas","year":"2012","journal-title":"Dig Surg"},{"key":"R5-20251008","doi-asserted-by":"crossref","first-page":"64","DOI":"10.1111\/j.1445-2197.2005.03280.x","article-title":"Anal abscesses and fistulas","volume":"75","author":"Rickard","year":"2005","journal-title":"ANZ J Surg"},{"key":"R6-20251008","doi-asserted-by":"crossref","first-page":"793","DOI":"10.1007\/s00384-011-1189-5","article-title":"Non-cutting setons for progressive migration of complex fistula tracts: A new spin on an old technique","volume":"26","author":"Subhas","year":"2011","journal-title":"Int J Colorectal Dis"},{"key":"R7-20251008","doi-asserted-by":"crossref","first-page":"201","DOI":"10.1007\/s13304-013-0216-1","article-title":"Fistulotomy or seton in anal fistula: A decisional algorithm","volume":"65","author":"Cariati","year":"2013","journal-title":"Updates Surg"},{"key":"R8-20251008","doi-asserted-by":"crossref","first-page":"172","DOI":"10.1111\/j.1463-1318.2009.01810.x","article-title":"Faecal incontinence after seton treatment for anal fistulae with and without surgical division of internal anal sphincter: A systematic review","volume":"12","author":"Vial","year":"2010","journal-title":"Colorectal Dis"},{"key":"R9-20251008","doi-asserted-by":"crossref","first-page":"3292","DOI":"10.3748\/wjg.v17.i28.3292","article-title":"Why do we have so much trouble treating anal fistula?","volume":"17","author":"Dudukgian","year":"2011","journal-title":"World J Gastroenterol"},{"key":"R10-20251008","doi-asserted-by":"crossref","first-page":"309","DOI":"10.3393\/jksc.2012.28.6.309","article-title":"The use of a staged drainage seton for the treatment of anal fistulae or fistulous abscesses","volume":"28","author":"Lim","year":"2012","journal-title":"J Korean Soc Coloproctol"},{"key":"R11-20251008","doi-asserted-by":"crossref","first-page":"459","DOI":"10.1007\/s10350-004-0830-6","article-title":"Long-term indwelling seton for complex anal fistulas in Crohn's disease","volume":"48","author":"Thornton","year":"2005","journal-title":"Dis Colon Rectum"}],"container-title":["Advanced Biomedical Research"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ovid.com\/01679891-201605000-00068","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,13]],"date-time":"2026-08-13T19:40:26Z","timestamp":1786650026000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ovid.com\/01679891-201605000-00068"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2016,1]]},"references-count":10,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2016]]}},"URL":"https:\/\/doi.org\/10.4103\/2277-9175.180637","relation":{},"ISSN":["2277-9175"],"issn-type":[{"value":"2277-9175","type":"electronic"}],"subject":[],"published":{"date-parts":[[2016,1]]},"assertion":[{"value":"2014-04-17","name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2015-02-02","name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}}]}}