What is a seton

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Date Joined Apr 2007
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   Posted 4/3/2008 3:42 PM (GMT -7)   
OK for all that know nothing to little about what a seton is:

A seton or seton stitch is a medical term for a procedure used to aid the healing of fistulae.

The procedure involves running a surgical-grade cord through the fistula tract so that the cord creates a loop that joins up outside the fistula. It is used to allow the fistula to continue to drain while it is healing, rather than allowing the exterior of the wound to close over, thereby potentially trapping pus and other infectious material in the wound (which can cause a future relapse). By repeated tightening of the Seton stitch, it can also be used to gradually cut through the fistula wall. The fistula gradually heals over behind the cutting Seton thereby slowly moving the fistula until it is outside the body and therefore no longer a problem. The procedure was mentioned by Hippocrates. Reference: Wikipedia

Please feel free to add to this as I am one of the people that did not understand just what one was either. redface

Thank you

Kitt, Moderator: Anxiety ~ Panic  ~ Crohn's
Not a mental health professional of any kind
It is health that is real wealth and not pieces of gold and silver.~Mahatma Gandhi~

Elite Member

Date Joined Sep 2005
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   Posted 4/4/2008 7:53 PM (GMT -7)   
Thanks for posting this, Kitt. I didn't know what a cutting seton was, and now I do!

Co-Moderator Crohn's Forum.

Veteran Member

Date Joined Nov 2005
Total Posts : 722
   Posted 4/5/2008 6:46 AM (GMT -7)   
Hello from the land of setons! :-)
Another note about the "cutting seton" that might help people understand how it works and why it is done is something my surgeon explained to me:
Think of it like a piece of string cutting through a block of ice. When they tighten it, it is a gradual cut, like shaving a piece of ice with a string. It is done so that the muscle is not destroyed and the patient does not become incontintent.
I have done a lot of research and have had several discussions with several Drs. regarding  procedures for fistulas. you would think they would have some better ideas for us by now. It seems so Frankenstein like....... tongue
37 year old female. Dx'd and undx'd a few times. Was just redx'd again 04/2007.
History of rectal abscesses and fistulas (29 surgeries including abscess I & D, exploratory surgeries, 4 C-ton drains and 1 fistula plug) Have also had several self bursting abscesses.
1st Remicade infusion 6/5/07-still taking it.  Praying I'll get better soon so we can have a baby.
Ginger :)

New Member

Date Joined Nov 2009
Total Posts : 3
   Posted 12/1/2009 9:26 PM (GMT -7)   
Thanks Kitt for the info. You mentioned that relapse can occur. What causes it and is it fairly common. How can it be prevented.

Regular Member

Date Joined Sep 2008
Total Posts : 28
   Posted 12/2/2009 12:32 PM (GMT -7)   
Thank you so much for this information. Does anyone know how long this procedure takes? and can you walk about as normal while it is in?

Veteran Member

Date Joined Feb 2003
Total Posts : 1441
   Posted 12/2/2009 12:44 PM (GMT -7)   

Thanks stkitt! 

Hey, I'm surprised that the word "seton" didn't show up underlined with the definition after you posted!  LOL tongue

That's why I hate all the underlined words.  The ones that need to show up with a definition sometimes doesn't and the words that shouldn't be underlined are and have the wrong definition!  Ugh! rolleyes

 Bipolar - 2004
     Crohns disease - 1995 
Arthritis & Fibromyalgia 
Leo Buscaglia

Veteran Member

Date Joined May 2009
Total Posts : 703
   Posted 12/2/2009 5:06 PM (GMT -7)   
Wow, that's pretty wild! Like in T2 when the T1000 removes the pole from his abdomen by sliding it sideways. I had no idea they did that with setons--I only knew they were silk strings or something, used to aid drainage. I recently saw a photo of a fistula and wondered why it looked like a big long gash.
Cimzia, Asacol

New Member

Date Joined Sep 2011
Total Posts : 4
   Posted 9/20/2011 9:46 AM (GMT -7)   
I had a seton put in last week, and you are fine to walk right after. This is the second surgery for a seton; the first one did not go well because I played in the snow the next day and had to be driven to the emergency room due to bleeding and had that one removed. I was just wondering how long they were kept in for my doctor did not say and I dont see him for another month?

Jonny Five
Regular Member

Date Joined Sep 2009
Total Posts : 107
   Posted 9/20/2011 1:08 PM (GMT -7)   
In people with Crohn's, setons are typically left in until the fistula heals.  This offers a few options:
1) Use of a cutting seton to encourage the fistula to fully heal - the seton is removed once the cutting seton has reached the skin and its job is complete.
2) The fistula heals on its own, or with the help of some medications that are shown to encourage fistula closure (i.e. anti-TNF biologics).  The seton is removed if the fistula is no longer draining and appears to be closing on its own.
3) The fistula continues to drain or cause some discomfort and does not fully heal - the seton may be left in permanently in this case.
I hope that helps out for now!  It's a good idea to discuss this with your doctor so you are both clear on what outcomes you expect and how your treatment is guiding you towards those goals.  I hope everything works out for you.

Jonny Five
Regular Member

Date Joined Sep 2009
Total Posts : 107
   Posted 9/21/2011 8:01 AM (GMT -7)   
Unfortunately you've gone beyond my knowledge of setons with those questions.  Maybe someone else will have an answer - I'd suggest starting a new topic if you don't get replies to this one, attaching onto an old topic often doesn't get as many replies.
Your seton sounds like one I currently have.  I have a draining seton placed in order to keep an abscess open so it can drain.  It is a seton that loops through two cuts into the abscess; it does not loop around through the anus.  The surgeon was unable to find the fistula at the time of the operation, but he will look again when the abscess heals up some more (I had a fistula connecting to a peri-anal abscess).
Typically the seton is removed by your surgeon simply by cutting it and removing it.  It does not have to be done under anethesia and there should be no pain because at that point everything is healed up.

New Member

Date Joined Sep 2011
Total Posts : 10
   Posted 9/21/2011 8:28 AM (GMT -7)   
Thanks Jonny Five - I am going for my next post op appointment Sept 27th, and am taking my mother with me so that she can take notes (seeing how my anxiety seems to not be going away) Im hoping that I will have a better understanding of what is going on.
Just out of curiousity, how long have you had your seton?

Elite Member

Date Joined Apr 2005
Total Posts : 14995
   Posted 9/21/2011 9:04 AM (GMT -7)   
Guys this is a nearly 3 year old post, in the future please start a new thread. Thank you!
Gail*Nanners* Co-Moderator for Crohns Disease
Crohn's Disease for over 35 years. Currently on Asacol, Prilosec, Estrace, Prinivil, Percoset prn for pain, Zofran, Phenergan, Probiotics, Calcium, Vit D, Folic Acid and Xanax prn. Resections in 2002 & 2005. Also diagnosed w/ Fibromyalgia, Osteoarthritis, & Anxiety. Currently my Crohns is in remission, but my joints are going crazy!
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