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Last Updated on November 26, 2025 by Bilal Hasdemir
Treating complex anal and perianal fistulas is a delicate task. It balances healing with managing pain. A seton suture is often used. It’s a medical device that helps with drainage and healing.
Liv Hospital combines patient care with advanced seton placement techniques. This approach offers reliable solutions for fistula challenges. The procedure is done under general anesthesia in an outpatient setting. It involves placing a string-like material in the surgical fistula to aid in drainage over weeks or months.
This guide will show you the seton surgery process. It highlights its benefits, mainly in complex or high-risk cases. It also explains how it improves quality of life.
Fistulas are abnormal connections between body parts. They can form between the intestine and skin or between different parts of the intestine. Knowing about fistulas is key for managing and treating them.
A fistula connects two body parts that shouldn’t be joined. It can happen due to diseases like Crohn’s, trauma, or surgery issues. The body forms a tract lined with granulation tissue, making it hard to heal.
Key aspects of fistula pathophysiology include:
Fistulas can come from many sources, such as:
The risk factors for getting a fistula include:
| Risk Factor | Description |
| Crohn’s Disease | A chronic inflammatory bowel disease that can lead to fistula formation. |
| Previous Surgeries | Surgical interventions in the affected area can increase the risk of fistula development. |
| Infections | Recurrent or severe infections can contribute to fistula formation. |
Fistula surgeries often need repeated efforts. Seton surgery involves staged operations and careful follow-up. Understanding fistulas’ causes and risks is vital for effective treatment.
A seton drain is used to keep a fistula open for healing. It’s a key tool in treating fistulas, mainly in hard cases. This device helps keep the fistula open, making it easier for it to heal.
A seton drain is a flexible tube or string used in fistula treatment. It keeps the fistula open for drainage and healing. For centuries, setons have been used in medicine, including for fistulas.
Over time, seton use in fistula surgery has improved. Better materials and techniques have led to better results. This shows how important setons are in treating fistulas.
Seton drains come in different materials like silicone, nylon, silk, or surgical suture. The choice depends on the procedure and the surgeon’s choice.
A seton drain works by keeping the fistula open for drainage. This stops debris and bacteria buildup. It helps prevent abscesses and promotes healing.
It also reduces inflammation and aids in tissue repair. By keeping the fistula open, it helps it close from the inside. This lowers the chance of it coming back.
Seton surgery is a top choice for tough fistula cases. Seton placement is best for complex or high transsphincteric fistulas. It’s also good for those with fistulas that keep coming back.
Complex fistulas have many tracts or are linked to Crohn’s disease. High transsphincteric fistulas are hard because they go through a lot of the anal sphincter. Seton placement helps avoid cutting important muscles, lowering the chance of bowel incontinence after surgery.
This method lets the fistula heal slowly and keeps the sphincter safe. It’s a good choice for these hard cases.
Recurrent fistulas are tough because of scar tissue and changed anatomy. Seton surgery is great here because it’s gentle and doesn’t harm the fistula tract much.
Patients with inflammatory bowel disease or who’ve had surgery before need special care. Seton placement can be adjusted for each patient’s needs.
Planning before surgery is key to avoiding problems and making recovery smoother. A detailed check-up before surgery helps spot risks and choose the best surgical method.
A thorough check-up is the first step in pre-operative planning. It includes a detailed medical history and physical exam. This helps understand the patient’s health and the fistula’s specifics.
Key components of clinical evaluation include:
Imaging studies are vital for mapping the fistula accurately. MRI and endoanal ultrasound give detailed views of the fistula and its surroundings.
Accurate fistula mapping helps in identifying the most appropriate treatment strategy, reducing the risk of complications and improving outcomes.
Laboratory tests add to the clinical evaluation and imaging studies. They provide insights into the patient’s health and risks. Blood tests can check for infection or inflammation markers.
Laboratory tests help in:
By combining clinical evaluation, imaging studies, and laboratory tests, healthcare providers can make a detailed pre-operative plan. This approach reduces risks and improves the chances of a successful surgery.
Before getting a seton, patients need to prepare well to avoid problems. Good preparation is key for a successful procedure and treatment.
Bowel prep is a big step before seton placement. Mechanical bowel preparation helps lower infection risk and makes the surgery area cleaner. The prep method depends on the patient’s health, fistula complexity, and the surgeon’s choice.
Patients might use laxatives or enemas to clean their bowels. The prep plan is made just for the patient, mixing diet changes and mechanical cleansing.
Antibiotic prep is also vital for seton placement. Antibiotics before surgery cut down infection risk. The antibiotic and when to take it depend on guidelines and the patient’s risk.
Studies show antibiotics can greatly lower infection rates after surgery. Pre-operative antibiotics should be given a certain time before surgery. This ensures they’re effective during the procedure.
The seton suture procedure is key for managing fistulas. It’s a detailed surgical method that needs careful planning and execution. This ensures the best results for the patient.
The surgery is done under general anesthesia to keep the patient comfortable. The patient is placed in a position that gives the surgeon the best view of the fistula. This is usually a prone or lithotomy position.
After the patient is under anesthesia, a detailed examination under anesthesia (EUA) is done. This helps the surgeon understand how complex the fistula is and spot any problems that might affect the seton placement.
Finding the fistula tract is a vital part of the procedure. The surgeon uses a tool to gently explore the tract. This helps them see how it’s shaped and plan where to put the seton. A fistula probe is often used for this.
Putting in the seton is a precise step. The surgeon threads the seton through the fistula. They choose the seton material based on the fistula type and their preference. The seton is then tied in place with a silk or rubber suture. This helps with drainage and healing.
The main steps of the seton suture procedure are:
By following these steps, surgeons can manage fistulas effectively. This helps in healing and reduces complications.
Effective treatment of perianal fistulas needs a deep understanding of the complex anatomy. Surgeons must use various techniques to get the best results. They aim to preserve the function of the sphincter.
Keeping the anal sphincter intact is key in perianal fistula surgery. The anal sphincter complex is essential for controlling bowel movements. Damage to this area can cause serious problems after surgery.
Understanding the fistula’s relation to the sphincter muscles is important. Preoperative imaging studies, like MRI, help map the fistula. They also show risks to the sphincter.
Seton placement is a common method in perianal fistula surgery. There are two main types: loose seton and cutting seton.
| Technique | Description | Advantages | Disadvantages |
| Loose Seton | A drainage seton that allows for continuous drainage of the fistula tract. | Promotes healing by allowing drainage, reduces risk of abscess formation. | May require multiple adjustments, risk of seton migration. |
| Cutting Seton | A seton that is tightened over time to gradually cut through the fistula tract. | Can be effective for complex fistulas, promotes fibrosis. | Risk of incontinence due to sphincter damage, painful. |
The choice between loose and cutting seton techniques depends on the fistula’s complexity and the patient’s health.
In some cases, a combined approach is used. This includes fistulotomy and seton placement. It’s helpful for complex or recurrent fistulas.
Fistulotomy opens the fistula tract surgically. Seton placement ensures drainage and aids in healing. The decision for this approach depends on the patient’s condition and the fistula’s characteristics.
After a seton is placed, careful management is key for recovery and to avoid problems. This time is very important for the treatment’s success and for the patient to get back to normal.
Right after surgery, doctors watch for any signs of trouble like bleeding or infection. Patients usually stay for a few hours before going home. They get clear instructions on what to do next, like how much to move, what to eat, and when to take medicine.
It’s very important for patients to stick to these instructions. Keeping the wound clean and dry is essential to avoid infection and help it heal.
Managing pain is a big part of aftercare. Doctors often give pain meds to help with the discomfort. The kind and amount of medicine depends on the patient and the doctor’s choice.
If pain is bad or lasts too long, patients should tell their doctor. Good pain control helps patients get back to their usual life faster.
Looking after the seton drain is very important. Patients learn how to clean and care for it, and how to watch for any problems.
Keeping the area around the seton clean and dry is part of wound care. Regular check-ups with the doctor are needed to see how it’s healing and make any needed changes.
By following these steps, patients can lower the chance of problems and get the best results from their seton procedure.
Seton surgery often uses staged operations for the best results in treating complex fistulas. This method lets surgeons adjust their plan based on how the patient reacts to the first steps.
Planning for multiple surgeries in seton surgery depends on the fistula’s complexity and the patient’s health. Surgeons must carefully assess the fistula tract and consider factors such as abscesses or sphincter involvement.
Good planning involves a team effort. Radiologists, gastroenterologists, and colorectal surgeons all have a say. Advanced imaging techniques help understand the fistula’s anatomy.
The timing of each stage in seton surgery is key to success. The interval between stages lets surgeons check healing and adjust the plan if needed.
The timing depends on the patient’s healing, any complications, and the surgeon’s judgment. Regular follow-up appointments help track the patient’s progress and decide on the next steps.
Using a staged approach helps surgeons improve fistula closure chances and reduce risks. This strategy is very helpful for complex or recurring fistulas.
Seton surgery can lead to complications, showing the need for careful management. These issues can greatly affect how well a patient does and their quality of life.
Right after seton placement, patients might face infection and abscess formation. These problems often come from bacteria during the surgery or not taking good care after it.
It’s key to spot and treat these early problems quickly. This helps avoid more serious issues and makes sure the seton works well.
Complications can show up weeks to months later. These might include recurrence of the fistula, seton-related discomfort, or anal incontinence.
Keeping up with patients long-term is key. It helps catch and handle these late complications, aiming for the best results from seton surgery for fistula treatment.
After seton placement, it’s key to have a follow-up plan. This plan helps track healing and tackles any issues that come up. Good follow-up care is vital for seton surgery success in treating fistulas.
Follow-up visits are set based on how well the patient is healing and the fistula’s complexity. Usually, the first visit is a few weeks after surgery.
Regular follow-up visits help doctors check on healing, tweak the seton if needed, and handle any problems that pop up.
The seton might need adjusting or removing over time. This decision depends on how the fistula is healing and if there are any issues.
Checking on the fistula’s healing is a big part of follow-up care. Doctors look for signs like less drainage or the tract closing.
| Healing Stage | Characteristics | Intervention |
| Initial Healing | Reduced inflammation, initial closure | Seton adjustment |
| Advanced Healing | Significant closure, minimal drainage | Consider seton removal |
| Complete Healing | Fistula tract closed, no drainage | Seton removal, follow-up as needed |
Long-term care means keeping an eye out for fistula return and dealing with any late issues. Sticking to a detailed follow-up plan helps doctors get the best results and lowers complication risks.
Seton surgery can heal fistulas and leave little to no scars. This leads to great results for patients. A healed fistulotomy scar shows that the treatment was successful.
Seeing healed fistulotomy scars is a big win in treating fistulas. It shows the treatment worked well. Success is marked by no symptoms and healed scars.
Healthcare providers can improve patient care by understanding fistula treatment and seton surgery. Seton drains help heal fistulas and lower the chance of problems. This leads to better treatment results.
A seton drain is a medical tool for treating fistulas. It lets drainage happen and helps the area heal. Made from materials like silk or rubber, it’s put through the fistula to help with drainage.
Setons are used for complex fistulas and those that keep coming back. They’re good when simple treatments might cause problems like incontinence.
The procedure starts with anesthesia and checking the fistula under anesthesia. Then, the surgeon finds the fistula and puts in the seton. This ensures the area drains properly and heals.
Setons can be made from materials like silk, nylon, or rubber. Some are absorbable, like Vicryl. The choice depends on the case and the surgeon’s choice.
After surgery, care includes managing pain, taking care of the seton, and looking after the wound. Patients might need to prepare their bowels and take antibiotics to avoid infection.
Complications can include pain, bleeding, and infection right after surgery. Later, issues like a fistula that won’t heal or comes back can happen. Regular follow-ups help manage these problems.
Success is measured by a healed fistula scar and no recurrence. Regular check-ups are key to see how healing is going and to adjust the seton if needed.
Staged operations mean doing multiple surgeries to get the best results. This is helpful in complex cases where one surgery might not be enough.
Follow-ups should be regular to check on healing, adjust the seton, and handle any issues. How often depends on the case and the doctor’s advice.
A seton can be taken out when the fistula has fully healed. This usually takes weeks or months. The doctor decides when to remove it based on healing and any complications.
Jairath, A., & Kaur, M. (2021). Management of Anal Fistula: A Review of Advances and Surgical Techniques. International Journal of Surgery, 87, 105932. https://www.sciencedirect.com/science/article/abs/pii/S1743919121002933
