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An elastic seton has been used in more than 35 patients in the surgical management of anterior abscess-anal fistula and anterolateral anal fistula in women. Elastic setons are applicalbe in the treatment of other complicated abscess-anal fistulas. The advantage of this method is the good functional result, with a minimal deformity of the anus. The treatment can be administered with a minimal number of hospital days or, in some instances, on an outpatient basis.

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A preliminary report in 1965 described a conservative surgical procedure for the management of acute and chronic horseshoe anal fistulas. The operation has been used exclusively at the Ochsner Clinic for this problem since 1963. Forty-one patients were treated from 1963 to 1973. The paper reviews the pathology of acute and chronic horseshoe anal fistulas and describes the surgical procedure for both acute and chronic horseshoe abscess anal fistulas with accompanying illustrations. The excellent results with minimal deformity of the anus and anal canal are attributed to avoidance of severing the superficial external sphincter between its coccygeal origin and the anus. Of the 41 patients treated in the period from 1963 to 1973, healing was good, and there has been no recurrence.

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