Editing Anal fistula surgery (section)

=== '''Seton''' ===

* Allows     continuous drainage of sepsis, rather than intermittent build-up of pus
* Promotes     fibrosis and maturation of fistula tract, in preparation for second-stage     procedure
* Ensure not     too tight
* Second-stage     procedure 6-8 weeks later
* For some     Crohn's or other high-risk patients, seton can be definitive
* Draining     setons are good for recurrent infections or to mature a fistula tract for     definitive future treatment
** Probe the      tract. Tie a silk ligature to the probe and pull it through. Then tie the      ligature to a vessel loop and pull that through. Use two artery forceps      to clamp an appropriate length ready for tying. Tie three separate silk      ligatures on the overlapping part of vessel loop, then trim the ends. Try      to pull the seton through so the ties are on the inside.
* Cutting     setons are for trans-sphincteric or extra-sphincteric fistulas
** Only rarely      used now
** Tighten      every month
** Do not      tighten the seton over intact skin