setondrainage

Seton drainage is a surgical technique that uses a flexible cord, suture, or tube passed through a fistulous tract or abscess cavity and left in place to drain and manage the tract. The seton serves to maintain drainage and can function as a long-term drain or be used to gradually widen and transect tissue to promote tract maturation or healing. Two common approaches are a loose seton, which is placed with minimal tension to keep the tract open without cutting, and a cutting seton, which is periodically tightened to slowly divide the tract while allowing drainage.

Indications include anorectal fistulas, pilonidal sinus disease, hidradenitis suppurativa with chronic draining sinuses, and other chronic abscesses with complex tracts where primary closure could be unsafe or unlikely to heal. Placement is usually performed under anesthesia, with the seton threaded through the internal and external openings and secured externally. The duration varies from weeks to months and depends on the tract’s characteristics and treatment goals; some patients proceed to definitive closure or reconstructive procedures after tract maturation.

Benefits can include ongoing drainage, reduced risk of abscess formation, and a staged approach that may preserve function in anorectal disease. Potential risks include local infection, irritation or pain, extrusion or migration of the seton, skin breakdown, and incomplete healing or recurrence of fistulous tracts. Outcomes depend on the underlying condition and patient factors, and management is typically individualized.

The concept of seton drainage has a long history in surgical practice as a method to manage draining tracts while preparing tissue for future definitive treatment.