How to Insert a Draining Seton Correctly

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Misconceptions exist about the proper way to use draining setons in the management of anal fistulas. This technical note lays out the principles for their use.


Insertion of draining setons is a prerequisite to successful management of anal fistulas. The correct technique involves identification of the correct track and internal opening and drainage of the track with a silastic seton. This sets the stage for definitive repair after the inflammation subsides.


Three cases are presented to illustrate common errors made during the insertion of draining setons.


Appropriate seton drainage of an anorectal fistula is an important part of the ultimate repair. Correct use of setons minimizes symptoms from the seton itself and optimizes its effectiveness.

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