How long does a seton stay in for an anal fistula?

I know, I know, a bit like asking 'how long is a piece of string'?!

A little background. I do not have chron's nor do I have diabetes or any other illness of that kind. A year ago I got an anal abscess. got it drained twice, turned out it was a fistula. I went and had a staple op but that didn't work and after a recent MRI my specialist put in a seton last week.

Here's my question; my specialist said before the surgery that he would either do a flap or put in a seton. He said to do a flap it would have to look 'immaculate' inside my rectum. Anyway, he's put in a seton and from what I gather a seton is there so that the fistula can 'burn itself out', or something like that. Once that happens they can do a follow up operation. like the Flap or LIFT. What I don't get is that from my experience with my fistula it's a bowel movement that 'reinfects' it, so to speak. I have almost no pain or discharge until I have a bowel movement, and then an hour after, or sometimes a few hours, Ill get pus drainage and a throb that goes for a few hours then dies down.

Since I can't not use the bathroom it seems to me like the seton is only there to stop another abscess forming when skin heals over the external opening, but that wasn't an issue with me as the external opening never healed over anyway.

I really don't like the thought of a seton in for years. I've even found that the pain post bowel movement is WORSE with the seton in than it was when it wasn't there. It's only been 4 days since the op so I'm hoping my body will adjust and that will go away.

Can anyone explain the general routine with seton for people who don't have chron's?

Hi, thanks for your reply. I think Dimitri had a cutting seton, whereas I’ve got a draining seton (for now). Thanks.

What scifigal2k said - it depends. I'm surprised they put a seton in on someone without Crohn's. I thought they just operated for that and cut em open. Setons, I thought, were for Crohn's patients because of our super power of healing inability.

Sounds like you're in the same situation as me. My drainage seton was put in place in early 2012 and I was told at the time to just live with it. Like you say, the fistula is much too high to lay open without leaving me permanently incontinent and while a permanent seton isn't good, it's better than that.

I've never heard the expression 'burn out' before. The explanation I was given was that the seton was in place specifically to keep the fistula open. Without it, the track would try to heal, get bits of bowel movement stuck in it so another infection, another abscess and the fistula re-opening. The problems with a long term seton, from what I can find, are that to remove the seton and get the fistula to heal, you need to;
1. seal the entrance to the fistula in the anus to stop fresh BM material creating more infection;
2. remove the lining of the fistula (a bit like skin, but not the same) which will have developed around the seton, so the body can grow into and fill up the track.

Personally, I'm not convinced that either flap or LIFT address both problems fully. An advancement flap will seal the entrance, but they still need to deal with the track. LIFT deals with the intersphinteric track, but you would still need the entrance sealed. I'm hoping to persuade my CRS to send me for FiLaC, which I think is the best answer, provided they can get a good seal on the entrance.

Hope that's of help.