Gastrointestinal surgery: complex fistula-in-ano: practice question

A General Surgery question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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General Surgery · Gastrointestinal surgery: complex fistula-in-ano

Sample item

A man has a recurrent perianal fistula. MRI shows a high transsphincteric tract passing through a substantial part of the external sphincter. Which approach best preserves continence in the first stage?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

D. Loose seton placement

High tracts crossing a large amount of sphincter should not be laid open because division of the muscle risks incontinence. A loose (draining) seton keeps the tract open, controls sepsis and allows staged definitive treatment such as a sphincter-sparing procedure.

Option by option

  • A. Fistulectomy with core-out of the tract

    Coring out the tract damages the sphincter complex and leaves a large wound.

  • B. Primary fistulotomy

    Laying open divides a large amount of sphincter muscle and risks incontinence.

  • C. Cutting seton through the sphincter

    A cutting seton progressively divides the muscle and carries a real incontinence risk.

  • D. Loose seton placement (correct)

    Correct. A draining seton controls sepsis without dividing the sphincter.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

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Questions about this General Surgery question

What is the answer to this General Surgery question?

The best answer is D, Loose seton placement. High tracts crossing a large amount of sphincter should not be laid open because division of the muscle risks incontinence.

Why is "Fistulectomy with core-out of the tract" not the answer?

Coring out the tract damages the sphincter complex and leaves a large wound.

Why is "Primary fistulotomy" not the answer?

Laying open divides a large amount of sphincter muscle and risks incontinence.

Why is "Cutting seton through the sphincter" not the answer?

A cutting seton progressively divides the muscle and carries a real incontinence risk.

What concept does this question test?

It tests Gastrointestinal surgery: complex fistula-in-ano in General Surgery. A loose (draining) seton keeps the tract open, controls sepsis and allows staged definitive treatment such as a sphincter-sparing procedure.

How hard is this question?

We tag it as a multi-step question: it asks you to combine more than one idea. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Gastrointestinal surgery: complex fistula-in-ano?

Learn classic signs and eponyms alongside what they diagnose. Then use the flashcards and the other General Surgery questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.