I think that I'm spelling it correctly...

Anywho, I have a potential fistula that my surgeon wants to tackle with a seton. I've read conflicting articles on how they work.

Do they just remain in place and facilitate the wicking of stuff so that the fistula heals? ...or, are they gradually tightened and thereby slowly cut their way along so that the fistula and intestine gradual combine? (The point being that the fistula heals behind the seton as it cuts its way toward the intestine.)

Which is it?

Also, if it is the latter, three follow on questions:
1) doesn't that just result in a huge fissure at the end of the process?
2) Is the process painful?
3) How long does it take for the seton to cuts its way along?

Thanks in advance for sharing your comments and experiences.

The reason you are getting conflicting impressions is because there are two types of setons, cutting and drainage (which is non-cutting). The cutting seton will essentially do the same thing as sphincterotomy surgery, where the fistula is cut open and through the tissues gradually, hopefully having healing occur behind it. This is sort of like that science experiment where you have a weighted string on a block of ice. It cuts through the ice, but the ice refreezes as it goes along.

Yes, it can be painful (as can the non-cutting seton). It does not result in a fissure, because it is a gradual cut that heals as it goes. As for how long it takes, should be weeks to months, but I am sure that others will come in and tell you about it. Also, you can get both types of setons for one fistula.

http://www.sma.org.sg/smj/4306/4306a6.pdf

Jan

Thanks a ton Jan (as usual). That was a great article.

I had a seton inserted just 3 days ago with not much explanation by my doctor as it was emergency surgery. this clears things up but what am i wondering is, how long will the seton stay in for, i know i have to have more surgery in 3 weeks, would this be to remove it??

thanks

Good questions. You should ask your surgeon what the procedure will be. Sometimes it is to change it for a different seton, add a second one, do some cleaning up, or just exploration under anesthesia.

Jan

I have a seton drain.

I first had them in 2004, I had a peri-anal abscess with four fistula's, had emergency op to get rid of the abscess and woke up with four seton drains! Did not know anything about them and the docs were not very informative, so looked on the internet! I didn't have a good time with those, they stayed in for about 6 months. 2005 I had another two fistulas which resulted in 2 more seton's, one taken out a year later and I still have one in after two years, I don't really notice it anymore.

Jolene

I had the cutting seton years ago for a fistula. I don't remember it causing me any real pain, although back then I had so much pain I can't rememeber much. THe first was a string like material, and I went every week or so to the doctors and he tightened, not really painful. THen it fell out once on its own and the doctor put in a seton like a rubberband at first I felt this one a bit, but got used to it.
Good Luck!

How long does it take to get used to the pain? i understand everyone is different. i often get a sharp pain, which doesnt last for long, would this be because of the seton? Im interested to know as much as possible.

Thanks