My new surgeon does a knotless seton, using suture material to make an endless circle. I still have my knotted seton, but will have a scope with him soon, and may have him change it out.

He said he could do it in the office, they sort of "link" the seton a together and "pull it through" the existing tract, so small discomfort (he says), but I have been pretty ok with my current seton so we left it alone. Of course, I'm tapering down *super* slowly off steroids (steroids = little discomfort for me), so not sure if I'm masking things or not. But it also clues everyone in that my issues are likely IBD, because trey respond to steroids.

Thanks Rachel.  I asked about a knotless seton in April of '14 and was told not available.  I'm really hoping it's there now, this knot is becoming more and more annoying/uncomfortable.  I'll probably be going in for the replacement in a month or 2, will update then.

If your doctor doesn't know how to do a knotless seton, it mat be impossible to persuade them to do it. I'd suggest having the conversation before procedure time.

Thanks Scott - definitely in my plans.  If she does not do them, however, I don't know what I'll do, as I do like her and have been seeing her a couple years now.  We'll see what she says, first ...