Typically made from a large silk suture, silastic cord, or surgical rubber band, a seton is used to help heal fistulas by allowing a fistula tract to drain, while helping to avoid septic and potentially painful collections of pus or infection.[1]

A colorectal surgeon places a seton by running it through a fistula and creating a loop that joins outside the fistula. A seton allows the fistula to drain without allowing the wound to “heal over.” The two ends of seton are tied together, clasped, or clamped to complete the loop and to avoid having the seton being prematurely removed.[2]

There are typically two kinds of setons: “cutting” and “non-cutting” varieties. A non-cutting seton, also referred to as a “draining seton” or “loose seton,” is most often used in cases where the patient has Crohns disease.[3] Approximately 25% of Crohn's disease patients develop an abscess or a fistula at some point in their lives.[4] In cases where a non-cutting seton is used, the surgeon may elect to have the seton stay in place, require additional surgical procedures, use a fibrin glue or a collagen "plug" procedure[5], or employ the use of one of the biological therapies.

A cutting seton may be chosen by the surgeon, where the seton is tightened periodically, allowing it to slowly cut tissue and the wound to heal or scar behind the loop. This managed cutting and healing process eventually pulls out the seton without additional surgery.[6]


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