SETON IN A COMPLEX ANAL FISTULA

DISCLAIMER- MEDICAL EDUCATIONAL VIDEO. NOT TO PROMOTE SEXUALITY OR NUDITY.

Fistula in ano is a common proctological disease. Several authors stated that internal and external anal sphincters preservation is in the interest of continence maintenance. Anorectal fistulas are common maladies. The challenge in therapy of perianal fistulas balances between the best possible cure and the preservation of continence. Invasive methods with high rates of incontinence have given way to sphincter-sparing methods that have a much lower associated morbidity.

A seton is a piece of surgical thread that's left in the fistula for several weeks to keep it open.
This allows it to drain and helps it heal, while avoiding the need to cut the sphincter muscles.
Loose setons allow fistulas to drain, but do not cure them. To cure a fistula, tighter setons may be used to cut through the fistula slowly.
Perianal abscesses and fistulae-in-ano are a common anorectal complaint causing significant distress to patients, and present a considerable treatment challenge. Principal of treatment is achieving closure of the fistula while maintaining continence. There are numerous treatment approaches with large debate about which method is "ideal." Overall, loose seton placement remains a well-tolerated, pragmatic low-cost solution to this common and difficult condition.
The loose seton technique for trans-sphincteric anal fistula carries favorable results and can be safely applied while preserving the external sphincter function.
Fistula in ano is a common proctological disease. Several authors stated that internal and external anal sphincters preservation is in the interest of continence maintenance.

What is a seton?
A seton is a thin silicone string (very similar to an elastic band) which is inserted into the fistula tract. This allows the fistula to drain and heal from the inside out. This procedure is normally carried out under general anaesthetic. This means you will be asleep throughout the operation.
After the seton has been placed in the fistula tract, the wound will be covered with a light, padded dressing. As long as there are no complications, you should be able to go home later in the day.
Fistula surgery is often "staged". This means that it may be done over a series of operations. If necessary, further operations may be carried out to adjust or replace the seton. Your surgeon will discuss future procedures with you at your follow up. They will usually plan a further operation (or operations) for your fistula after a few weeks or months.
What to expect
The fistula will continue to drain as before. Do not worry, this is a normal process. Drainage can continue for a number of weeks following placement of the seton.
Setons
A seton is a foreign body (eg, a fine rubber sling or a heavy nylon suture), which is passed through the fistula and tied at its exit to the skin. There are two types of seton: cutting and loose. Loose setons can be used to drain sepsis when a procedure to cure the fistula is not intended. A loose seton may be removed in the outpatient department after a few months or replaced under anesthetic.
A cutting seton is one that is placed snugly around the part of the fistula track that passes through the external sphincter. Before placing the cutting seton, the superficial component of the fistula is laid open. The cutting seton is tightened in the outpatient setting or at a future EUA. In the search for the least uncomfortable material with the lowest rate of incontinence, many materials have been tried, including self-locking cable ties (inexpensive, commercially available nylon bands with a ratchet) in one study from Turkey. However, the incontinence rate of the cutting seton is approximately 12% overall (including incontinence of flatus) as reported in a literature review by Ritchie et al
Several operations involving setons may be performed over several months, with more of the track being laid open each time. This is known as a staged fistulotomy. Removal of a loose seton without a staged fistulotomy results in healing in the majority of patients, with very little postoperative incontinence; however, long-term follow-up shows that the majority of these fistulae recur with time . Some authors advocate the use of a loose seton alone, especially because this makes incontinence very unlikely and is a comfortable long-term strategy in patients with Crohn’s disease. However, loose setons are more frequently used as part of a surgical strategy that combines the various available treatments.