Premium Nahrungsergänzungsmittel | artgerecht

Anal Fistula Seton – Treatment Explained

An anal fistula seton is a surgical technique for treating anal fistulas, in which a thread or suture is passed through the fistula tract to promote gradual healing.

Regular tips about health Regular tips about health

Things worth knowing about "Anal Fistula Seton"

An anal fistula seton is a surgical technique for treating anal fistulas, in which a thread or suture is passed through the fistula tract to promote gradual healing.

What Is an Anal Fistula Seton?

An anal fistula seton is a well-established surgical method used in the treatment of anal fistulas. An anal fistula is an abnormal tunnel connecting the anal canal or rectum to the skin surface around the anus. A seton – typically a thread, silicone band, or suture material – is passed through this fistula tract. The technique aims to either gradually divide the sphincter muscle in a controlled manner or to drain the tract and reduce inflammation while preserving continence.

Types of Seton

Cutting Seton

A cutting seton is progressively tightened at regular intervals of several weeks. This slowly cuts through the sphincter muscle while simultaneously allowing scar tissue to form, which helps maintain continence. This method is commonly used for high or complex anal fistulas that involve a significant portion of the sphincter.

Loose (Draining) Seton

A loose seton is placed loosely through the fistula tract and left in place for an extended period. It keeps the tract open, allowing continuous drainage of secretions and pus, thereby reducing inflammation and preparing the tissue for a later definitive surgical procedure. This approach is frequently used in patients with Crohn disease or particularly complex fistulas.

When Is a Seton Used?

Seton placement is indicated in the following situations:

High anal fistulas that traverse a significant portion of the sphincter muscle
Complex or branching fistula tracts
Perianal fistulas associated with Crohn disease
Patients at elevated risk of postoperative fecal incontinence
As a bridge to further surgical intervention (e.g., advancement flap, LIFT procedure)

Diagnosis and Preoperative Assessment

Before seton placement, the fistula is carefully evaluated. Diagnostic methods include:

Proctological examination: Visual inspection and digital rectal examination
Endoanal ultrasound: Visualization of the fistula tract and its relationship to the sphincter
Pelvic MRI: Particularly valuable for deep or complex fistulas to define anatomy precisely
Fistula probe examination performed intraoperatively

Surgical Procedure

The procedure is typically performed under spinal or general anesthesia. The surgeon identifies the fistula tract using a specialized probe and threads the seton – usually a silicone vessel loop, nylon tape, or absorbable suture – through the tract. The ends of the thread are tied together or secured outside the body. With a cutting seton, the thread is progressively tightened during outpatient follow-up visits.

Benefits and Risks

Benefits

Protection of the sphincter muscle and prevention of incontinence
Controlled, stepwise tissue healing
Effective drainage in cases of ongoing inflammation
Suitable for complex and recurrent fistulas

Risks and Side Effects

Temporary pain and sensation of a foreign body in the anal region
Possible infection or inflammation around the seton
Risk of sphincter impairment in rare cases despite careful technique
Potential fistula recurrence after seton removal
Longer treatment duration compared to direct surgical approaches

Aftercare and Healing

Following seton placement, regular follow-up appointments are essential. Patients are advised to maintain good anal hygiene, for example through regular sitz baths. With a cutting seton, the thread is tightened every two to six weeks. The total treatment period may extend over several months. After completion of seton therapy, a further surgical procedure is often required to achieve definitive closure of the fistula.

References

Vogel J.D. et al. – Clinical Practice Guidelines for the Management of Anorectal Abscess, Fistula-in-Ano, and Rectovaginal Fistula. Diseases of the Colon & Rectum, 2016.
Ommer A. et al. – S3 Guidelines for Cryptoglandular Anal Fistulas, German Society of Coloproctology (DGK), 2016.
Parks A.G., Gordon P.H., Hardcastle J.D. – A classification of fistula-in-ano. British Journal of Surgery, 1976.

Building Blocks for a Healthy Life

As an integrated manufacturer, we develop & produce evidence-based, patented, and non-patented formulations. We work exclusively with plant and natural extracts according to the strictest purity & quality standards.
The combination of science & modern technology with the laws of nature creates solutions consistently tailored to humans – for the highest good: health.

Most read entries

3 Posts in this encyclopedia category