Coordinated filling and drainage of the anorectal vascular plexus is regulated by intrinsic vascular sphincter mechanisms. Both morphological and functional failure of this vascular system may contribute to the development of hemorrhoidal disease.

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A long-term, indwelling seton is a good alternative to primary surgical treatment of low transsphincteric and intersphincteric anal fistulas. Relapse quota is comparable with that of primary surgically treated cases; incontinence is rarer with long-term, indwelling seton. Complete treatment can generally be performed in the outpatient department. One disadvantage is that therapy takes much longer than cases treated by primary surgery.