03-09-2016, 06:02 PM   #1
Join Date: Mar 2016
Fistula surgery

Hello all first post here. Just had surgery for my fistula yesterday. Don't want to second guess my doctor at this point. But, sitting here I'm a bit confused. I think a big part of it is me not asking enough questions initially. Any way, my Dr had indicated my fistula appeared straight forward, superficial. But after my surgery, he had placed a Seton. I'm not sure at this point if it's for cutting or simply for drainage. I have a follow up in a few days and will have questions. I understand a Seton is used for complex or high fistulas. I just don't equate that to a simple or superficial fistula. Am I wrong? Or do some colorectal surgeons use a cutting Seton out if caution? Even for low simple fistulas. Thanks for any replies.
03-10-2016, 12:08 PM   #2
Join Date: Dec 2014
Sorry to hear your struggle. It is good for you to understand the anatomy of your fistula from the surgical notes or by directly asking your doctor. There are lot of information online about anal fistula, particularly on the anatomy of it. If your fistula is low-anal, then your CRS would have attempted lay-open fistulotomy - the most successful surgery for anal fistula. If sphincter muscles are suspected to be involved, most CRS will be very conservative and not lay it open, and instead, put a Seton in for drainage or for cutting. The tightness and type of the Seton should indicate whether it is cutting or drainage. Although, you may just ask your doctor or read his surgery report.

Good luck to you.
Abscess Fistula Sufferer (11/2013 - 6/2015)
My anal fistula story - https://fistulapatient2patient.wordpress.com/
03-10-2016, 02:27 PM   #3
Join Date: Mar 2016
Thank you
03-13-2016, 04:08 AM   #4
CarlyL's Avatar
Join Date: Sep 2015
Location: Manchester, United Kingdom
Hello, hope you are well.

My surgeon put a rubber band seton in for my last surgery and it is a loose one for drainage. I have also had two thread setons also for drainage.

The loose ones literally have a gap and can move around from side to side once the intial shock of the surgery is over and all dried blood/tissue has calmed down. That's how you can tell if its loose for drainage.

I am due to have a cutting seton in April and the surgeon said it will be really flush with the skin immediately and for the first few weeks whilst my body gets used to it. He said it will feel tight- my current seton has just dangled loose since the procedure and now spins around freely from side to side.

Also setons are used to give the fistula chance to drain and calm any inflammation before further procedures can be performed. I have had mine in from 4-8 months at a time in-between surgeries. I don't think it means it is particularly complex or superficial, I think it is the common practice in any fistula to place a seton if an immediate fistulotomy (laying open) cannot be done safely. Maybe the surgeon won't know until the fistula has had time to drain and then will re-assess the situation.

Hope the above makes sense. :-)
03-13-2016, 06:25 PM   #5
Join Date: Mar 2016
Thanks for the info.

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