What is a seton and how is it used in the treatment of anorectal abscess?

Updated: Jul 24, 2020
  • Author: Andre Hebra, MD; Chief Editor: John Geibel, MD, MSc, DSc, AGAF  more...
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Setons may also be used as temporary initial intervention in the management of a fistula. A seton is a nonabsorbable nylon or silk suture that is guided through the fistula tract and tied exteriorly, in this way compressing and maintaining suture placement in the tract. A soft vessel loop may also be used for seton placement. The seton suture must be left in place for a prolonged period (weeks to months).

The ischemic compression created by the seton and the local inflammatory reaction of adjacent tissues initiate fibrosis. Once fibrosis of the surrounding tissue develops, it helps to maintain the integrity of the sphincter musculature during subsequent fistulotomy. Setons often are used in patients with fistulas secondary to inflammatory bowel disease (IBD). In addition, setons allow epithelialization of the fistulous tract, thereby preventing secondary closure and facilitating the drainage of abscesses.

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