Seton Placement
A surgical thread placed through the fistula tract - used for complex or high anal fistulas as a draining seton to control infection or a staged cutting seton to gradually address the sphincter safely.
What is Seton Placement?
A seton is a thread or suture material passed through the fistula tract and tied loosely (draining seton to control infection and allow inflammation to resolve before definitive repair) or progressively tightened (cutting seton). Draining setons keep the fistula open, manage discharge, and prepare the tract for a subsequent sphincter-preserving closure. Cutting setons slowly cut through the sphincter over weeks, allowing fibrous healing alongside. Dr. Samhitha Reddy, a leading fistula specialist in Hyderabad, uses seton placement at Lux Hospitals as part of a staged treatment strategy for high trans-sphincteric and complex anal fistulas - particularly those associated with active infection or where a sphincter-preserving definitive procedure (LIFT, FiLaC) is planned for the second stage.
How the Procedure Works
Assessment & Imaging
MRI pelvis and endoanal ultrasound characterise the fistula, identify secondary tracts, and confirm classification (high trans-sphincteric, suprasphincteric).
Anaesthesia & Tract Identification
Examination under anaesthesia (EUA) identifies internal and external openings. A fistula probe confirms the tract path and sphincter involvement.
Seton Insertion
A silicone sling, nylon suture, or similar material is threaded through the fistula tract and tied loosely (draining) or secured for graduated tightening (cutting seton).
Seton Management Phase
Patient reviewed every 4–6 weeks. The seton drains discharge, allows inflammation to settle, and prepares the tract for the definitive procedure.
Definitive Procedure
After 6–12 weeks, the definitive sphincter-preserving procedure (LIFT, FiLaC, advancement flap) is performed for complete fistula closure.
Outcomes
Who Needs This Treatment?
- →Controls infection and drainage while definitive repair is planned
- →Allows inflammation and induration to resolve before complex sphincter-preserving surgery
- →Staged approach reduces incontinence risk for high complex fistulas
- →Day-care procedure for seton insertion - no extended hospital stay
- →Preserves the full range of sphincter-preserving definitive options for the second stage
- →Well tolerated - most patients adapt quickly to the seton during the waiting phase
The seton is one of the most strategically important tools in managing complex fistulas. It buys time, controls infection, and gives us the best possible conditions for a successful sphincter-preserving closure in the second stage.
— - Dr. Samhitha Reddy, Consultant Proctologist & Laparoscopic Surgeon
Common Questions
Frequently Asked
Not sure which treatment is right for you?
Book a consultation with Dr. Samhitha Reddy and get a personalised treatment plan.