I keep reading about setons used for fistulas. I'm having a hard time conceptualizing what they are and how they function. They say there's no such thing as a dumb question - if a seton is essentially a 'draining tube' then how does the stool not just seep around the tube? Can they be useful for recto vaginal fistulas? Can they be a permanent solution? Thanks for any light you can shed on this seemingly simple solution that has me confused.
Replies sorted oldest to newest
No, not a drainage tube, but it does facilitate drainage. A seton is like a big stitch that loops through the fistula. It keeps it open while it might heal without an abscess forming. Different materials can be used like rubber band or coarse suture. Another type is a cutting seton that is gradually tightened and it cuts through the tissues with a healing path (like a string cutting through ice with pressure and the ice refreezes in its wake). They can be used for R/V fistulas. Sometimes they work, sometimes not.
https://en.m.wikipedia.org/wiki/Seton_stitch
Jan 
Thanks Jan. I think I can picture it. But if it allows drainage, and if the stool would just continue to drain into the vagina, I can't imagine this would be too helpful for me.
It’s helpful in the sense that it prevents abscess formation, which can hurt like hell. It doesn’t cure the fistula, and it will continue to drain, and the seton itself isn’t a delight, but for some fistulas that may be the best you can do.
Hm. Oh well. Always hopeful. I guess if a Seton would have been beneficial it would have been suggested a few years ago when this all began. Two failed flap repairs later and I guess I'm just looking for something. Anything is better than the present situation (careful what I wish for though??!!) I can't get into the surgeon for a few more weeks so I really have no idea what the options might be.
Thank you Scott and Jan. I was counting on you for an explanation.
JHendrix, I've had my 1st fistula with seton for 6+ years now. A newer one for about 5 months. My 1st one is termed an RV fistula, but it's not really, it comes out just below the V opening. Anyhoo, I was told by my CRS that a seton would allow the inside skin of the fistula to "heal", thus possibly helping a future repair attempt to be more successful. For me, apparently the healing didn't take place, but the draining did slow down quite a bit over time. I had planned on living with the seton forever - not interested in attempting any surgical fixes - but other circumstances have forced me to disconnect the jpouch and eventually have it removed. The 1st seton was never a real inconvenience for me. It absolutely prevented the painful fill/burst cycle.
I feel for you, and hope you and your surgeon can come up with a plan that works for you.
Thanks for your input N/a. I am correct in assuming though the seton would not stop the drainage of the stool from the pouch to where ever it ends?
Well, in my case it did not stop the drainage. I don't understand all there is to know about fistulas ... I personally still don't know how the seton could stop all drainage since my fistula is connected to something that holds poo (the jpouch). My drainage only let up - almost completely - after the pouch was disconnected. No source of poo, no drainage. I'm guessing if I were reconnected (NOT going to happen), the drainage would resume.
However, I think every fistula is different - widths, amount of infection, angles, whether it branches off, etc. and that will no doubt affect what your surgeon may propose as far as repairs. I know this isn't much help, but fistulas are so darn complicated, IMO. I wish you the best, and hope you keep us updated.