Question:Has anyone had their Draining Seton leading to their fistulas migrating lower??

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Dimitri71
Regular Member


Date Joined Jul 2017
Total Posts : 73
   Posted 8/25/2017 1:06 AM (GMT -7)   
Hello dear Fistula co-sufferrers!smile smile

I have a mid to high transphicteric fistula and a draining seton in site since the beginning of August 2017, almost a month now! As you may have read in my other posts I got no problems so far and the draining is progressively decreasing. Overall I would say a bearable experience.

My question is the following:
I've read in various academic papers that the draining seton "migrates" a fistula from high to low over time, so that fistulotomy / fistulectomy is easier.Has anyone in here had this experience in practice?

Your feedback is greatly appreciated as always.

All the best & keep the spirits up!!! Time is your friend with fistulas - In the end they lose yeah

Post Edited (Dimitri71) : 8/25/2017 2:10:38 AM (GMT-6)


scifigal2k
Veteran Member


Date Joined May 2012
Total Posts : 3315
   Posted 8/25/2017 5:39 AM (GMT -7)   
That's a really good question. I had my first seton for about 4 months, and my second for probably 2-3 years. When I got the second one put in, it ended up going through the sphincter muscle when it previously wasn't in the sphincter when the first one got put in (we had taken it out for a while to see if Remicade could heal it). But I don't know the relationship between all of it.
"For this thing I besought the Lord thrice that it depart from me. He said, My grace is sufficient for thee: for my strength is made perfect in weakness. Most gladly therefore will I rather glory in my infirmities; I take pleasure in infirmities, reproaches, necessities, persecutions, distresses, for when I am weak, then am I strong" 2 Cor

U B Tough
Veteran Member


Date Joined Aug 2015
Total Posts : 894
   Posted 8/25/2017 6:56 AM (GMT -7)   
Setons never stopped any abscessing or new fistulas from forming. 2 weeks after 2 setons were placed I formed another abscess. Setons were a disaster. Spent 6 weeks in hospital because of them and now I need to go back to ER due to another....
female, Canada

IVIG (on hold)


UC/Crohns - tested positive for MAP antibodies & mycobacterium
PG- remission
chronic perianal abscess and fistulas. Failed setons...it was pure torture.
started Stelara May 24, 2017. 100mg imuran

Hoping to start Anti-MAP drugs soon
Had a 10 week reprieve, now flaring...again. 4 years of flaring is tiresome.

dbrookenz
Regular Member


Date Joined Feb 2017
Total Posts : 32
   Posted 9/5/2017 7:11 PM (GMT -7)   
Hi Dimitri,

I've read a LOT about fistulas since my first abscess in Feb of this year. I almost feel like an expert. My specialist told me I knew more than a lot of his med students!

Don't take my word as gospel, I could be wrong, but from what I've read a draining seton rarely heals a fistula. It's used more to drain it out, so to speak, so that when you have further procedures done the fistula is no longer 'active'. I think they use the cutting seton to slowly cut through muscle so to lower the track enough to lay open.

That's my basic understanding. From what I've read you would know if you had a cutting seton as they would tighten it every week or so. The fact some people have draining setons for years suggest they rarely do much beyond keeping the drainage open and the fistula non active.

I've had my flap procedure 4 weeks ago. I feel cautiously optimistic at the moment but the wound is still open (2.3cm deep, was 4.5cm deep after op) and still drains a little bit. I'm also getting a bit of drainage out of my anus but the flap procedure is pretty brutal to your rectum (cutting a flap of skin inside, pulling it and stitching) so healing is going to take a while.

If this procedure fails then I might try a seton again (it was horrible last time) and see if I can get the LIFT.

Good luck my friend!

Dimitri71
Regular Member


Date Joined Jul 2017
Total Posts : 73
   Posted 9/6/2017 12:06 AM (GMT -7)   
Thanks Brookenz.
Man it's a tough cookie, them fistulas!
I am on my 5th week on the draining seton and I am aware it does not heal by itself, but there are some academic papers which claim that if you keep a draining seton for a long time, it works as a slow cutting seton (read: "Loose seton a misnomer for cutting seton")while many other papers also make similar claims....We are becoming fistula experts!!!
For now, the draining seton is fine for me. However, I can see the fistula next to it (the wound is slightly open and my doctor confirmed that what I am seeing is the fistula!) and it continues to drain - sorry for being graphic!
I am supposed to meet my CRS on he 15th of October to discuss a date for the FiLac Laser Operation.
In any case I am becoming more and more aware that this is a marathon! We have to keep our head high!
I read you post on your thread as well. Good luck with the Flap, hope it works for you.
Persistence, optimism and patience is the name of the game.
All the best dbrookenz.

dbrookenz
Regular Member


Date Joined Feb 2017
Total Posts : 32
   Posted 9/6/2017 1:07 AM (GMT -7)   
Don't worry about being too graphic, I've had more people looking at and touching around my butt area in the last 6 months than I have the rest of my life. 38 years. I'm over being modest about it!

I'll read up about setons. It may be where I hae to go if the flap doesn't work out. I've read a few bits and pieces about that procedure you might be looking at and it sounds really promising. you're right, this is a marathon, not a sprint. Theres so many weird complications or nuances to fistula issues that you can prepare for. We just have to remember that our bodies want to heal and it will come right in time!

Dimitri71
Regular Member


Date Joined Jul 2017
Total Posts : 73
   Posted 9/6/2017 3:12 AM (GMT -7)   
smilesmile Since you'll be reading take a look at this also "The role of loose seton in the management of anal fistula: a multicenter study of 200 patients" which was a study in Ireland (find the PDF version it's free).
38 is young - I am 46 with three kids,my own business, really hit me in my prime also! Prior to this never got sick!
You're right: We'll deal with it and in the end we'll win.

Dimitri71
Regular Member


Date Joined Jul 2017
Total Posts : 73
   Posted 9/6/2017 3:14 AM (GMT -7)   
By the way I 've found that reading papers is a little more encouraging than getting the statistics from the blogs.smilesmile where most people discuss negative experiences results.
The numbers are more encouraging in reality I believe.
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