Discuss Setons?

  • A Seton is a suture (silk, prolene etc) or a drain that is threaded into the cutaneous orifice of a perianal fistula, through the fistula tract, across the mucosal orifice of the fistula into the rectum, and then out of the anal canal.
  • Non cutting Setons are the treatment of choice in patients with high fistulas who have active inflammation of the rectosigmoid colon.  Setons are also used in recurrent fistulae or complex or multiple fistulae
  • A noncutting Seton maintains drainage of the fistula, thereby reducing the risk of perianal abscess formation. It also promotes fibrosis and helps in fistula closure.
  • Setons can be left in place indefinitely; however, they are generally removed in 6-8 weeks once the fistula begins to heal with medical treatment (biologics or immunomodulators)
  • Cutting Setons are used to cut through the fistula. The Seton is passed through the fistula and tightened (instead of loose as in non cutting Seton). The Seton is tightened on subsequent clinic visits. With time, the Seton gradually cuts through the fistula track and exteriorizes it (in effect fistulotomy). The cutting Seton is pulled out as it cuts through in 6-8 weeks.

Seton insertion for fistula

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