الفهرس 
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Abstract
A fistula in ano is a very common perianal condition associated with considerable morbidity and inconvenience to the patient. It is described as a hollow tract lined with granulation tissue that connects an in-depth primary opening inside the anal canal to a superficial secondary opening in the perianal skin. It is mostly nonspecific (idiopathic, cryptoglandular) with infection of an anal gland in the intersphincteric space as the initiating pathology
Ano-rectal fistulas have been a common surgical problem since ancient times. Seton techniques are still used successfully in the treatment of complex anal fistulas. High trans-sphincteric fistulas involving the upper two-thirds of the external sphincter remain a surgical challenge because incontinence may result from the division of muscle involving more than one-third of the sphincter. The principles of anal fistula surgery are to eliminate the fistula, prevent recurrence and preserve sphincter function.A seton can be any type of foreign body material inserted through a fistulous track.
Although setons have been used since Egyptian times. The word seton is derived from the latin (seta), meaning a bristle. Currently, many different materials have been used as setons, including silk, wires, elastic bands, Penrose drain and nylon and plastic tubing.
A high incidence of incontinence occurs when a simple lyingopen technique is applied. Staged fistulotomy with a seton is considered to decrease the incidence of incontinence problems after surgery. Cutting, losse and chemical setons are used in order to minimize the risk of anal incontinence. Application of a cutting seton after partial distal fistulotomy is used to treat patients with high extra-sphincteric fistulas in a successful manner with lower risks of recurrence or incontinence problems.
The main results of the study revealed that:
The mean age was 43.4±13.1, 70% were male, 30% were female.
The mean age at presentation is 40 years (range, 20–60 years). Males are twice as likely to develop a fistula in ano as females.
There were 40% class I, 50% were class II, 10% were class III. As regard location; there were 66.7% Transsphincteric, 16.7% were Intersphincteric, 16.7% were Suprasphincteric.
Location of high perianal fistula among studied cases; there were 3.3% at 1 o’clock, 16.7% were Intersphincteric, 16.7% were Suprasphincteric.
The mean Operation time (minutes) was 25.4±2.1, Time until seton removal (days) was 41.4±5.1, Time until normal activity (weeks) was 3.4±0.4. There were 53.3% with Seton fell on its own.
There were 20.0% with Gas incontinence, 3.3% had Liquid (Stool) incontinence, 76.7% with no Incontinence.
There were significant correlations between incontinence rate and male, location.