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Q. How is Seton[Thread] treatment done and what are disadvantages of this procedure?

A seton or thread is a loop of flexible material which is placed along the fistula track to maintain drainage for a period of time. It create scar tissue around part of the sphincter muscle before it is cut with a knife


·        Loose seton- In this method, the seton is placed to maintain drainage and create scar tissue around the sphincter so that it’s edges don’t retract after cutting.

·        Cutting seton- In this method, the seton is tightened gradually over regular intervals so that it slowly cut all the way through the muscle over the course of several weeks .


·        Less-invasive- The procedure involves less cutting though the final  scarring is comparable to Fistulotomy.

·        Less pain- The pain in this procedure is less compared to Fistulotomy.

·        Combined with other procedures- In complex fistulas ,this procedure can be combined with other procedures


·        Long follow up-The patient need to come for repeated follow-up visits especially in cutting variety.

·        High risk of Incontinence in


          -Anterior fistulas in female patients with a history of vaginal delivery

     -High trans-sphincteric and complex fistulas [ 30-50% incidence of incontinence to flatus or liquid by seton usage in complex fistulas- Joy et al- Colorectal Dis. 2002]

                                                                                                                                   A seton in the fistula




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Dr Pankaj