This procedure is not frequently carried out. It has been used in the past to treat fistulas that involve a lot of muscle. The principle is that by cutting through the sphincter muscles slowly, using a tight seton, they are not unduly damaged and problems with bowel continence and control do not follow.
What does the operation involve?
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The procedure is usually carried out under a short general anaesthetic as a day case. No particular bowel preparation is usually required. The procedure takes around 30 minutes to complete.
Your surgeon will carefully examine your anus and identify the fistula track using small probes.
The seton drain is then threaded through the track and tied firmly around the sphincter muscle.
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A simple dressing is applied afterwards.
The seton is then tightened up every 2 to 3 weeks. This may be carried out in the outpatient clinic or under a light anaesthetic. During this period the seton gradually cuts through the intervening tissue until it eventually drops out. Two or more tightening’s are usually required.
What are the risks?
There are small risks associated with any operation. Pre-operative assessments are made of any heart or lung conditions, as well as any other coexisting medical condition. During the hospital admission patients wear stockings. If you are staying overnight, you may be given tiny injections to prevent thrombosis (blood clots).
Bleeding is very rare in this type of surgery; most patients will notice small amounts of blood draining from the wound.
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You may continue to get discharge from the wound, this is quite normal and may continue until the wound fully heals. If you develop increasing pain or swelling in the area you should contact the clinic or your own GP.
What happens after the operation?
The procedure is not usually too uncomfortable. After the operation patients are given as regular stool softener. It is important to keep your bowels moving even though it may be uncomfortable to begin with.
You will be seen in clinic afterwards to assess progress.
For advice on looking after your bottom after the procedure please refer to our advice sheet. For more complex wounds we may ask you GP practice nurse to help with dressings.
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