An anal fistula is an abnormal tunnel. It forms between the inside of the anal canal and the skin near the anus. Most fistulas start from an anal abscess — a pocket of pus that bursts and leaves a track behind.
Simple fistulas pass through very little muscle. They can often be treated with a straightforward cut. But complex fistulas are different. They go deeper. They may pass through a significant portion of the anal sphincter — the muscle that controls bowel movements. They can have multiple tracts, multiple openings, or be linked to conditions like Crohn’s disease.
Cutting through a complex fistula directly risks damaging the sphincter. That damage can lead to faecal incontinence — a permanent and life-altering problem.
This is exactly why doctors use a different approach for complex fistulas. One of the most trusted methods is seton placement.
At Kaizen Fistula Care in Pune, complex fistula cases are handled with great care and precision using the most appropriate technique for each patient — including seton procedures when needed.
What Is Seton Placement?
A seton is a thin piece of thread, a rubber band, or a surgical suture. In the seton procedure, this material is carefully threaded through the fistula tract and tied loosely outside the body. It stays inside the tract — not to close it immediately — but to manage it over time.
There are two main types:
- Loose (Draining) Seton — Placed loosely. Its job is to keep the tract open for continuous drainage. It reduces infection and inflammation. It prepares the area for a future definitive surgery.
- Cutting Seton — Placed and then gradually tightened over several weeks. The cutting seton for a fistula works by slowly cutting through the muscle. Because it cuts slowly, the sphincter has time to scar and fibrose in place. This preserves function even as the tract is divided.
Both types serve a clear purpose — protecting the sphincter while managing the fistula.
Why Do Doctors Use a Seton for Complex Fistulas?
The answer is simple — safety.
Directly cutting through a complex fistula in one surgery puts the sphincter muscle at serious risk. If too much muscle is cut at once, the patient may lose bowel control permanently. The placement of a seton avoids this risk. It gives the tissue time to adapt. It allows fibrosis — a natural scarring process — to hold the muscle in position even as the tract is gradually dealt with. Additionally, complex fistulas are often inflamed and infected. Operating on an infected tract is risky. A draining seton first clears the infection. Once the tissue is healthy, a more definitive procedure becomes safer and more effective.
At Kaizen Fistula Care, Dr. Samrat Jankar evaluates each fistula individually. The decision to use a seton — and which type — is based on fistula height, sphincter involvement, patient history, and any underlying conditions like IBD.
When Is Seton Placement Recommended?
The seton procedure is recommended when:
- The fistula passes through a large part of the sphincter muscle
- The patient has a recurrent fistula after previous surgeries
- There is an active infection or abscess alongside the fistula
- The patient has Crohn’s disease or IBD with a perianal fistula
- There are multiple fistula tracts
- Previous fistula surgery has failed, and there is scarring
In these situations, jumping straight to fistulotomy or other definitive procedures is risky. The placement of a seton is the safe and responsible first step.
Benefits of Seton Placement:
The seton procedure offers several clear advantages:
- Protects the sphincter — This is the number one benefit. No sudden cutting of muscle means no risk of incontinence.
- Controls infection — Continuous drainage prevents abscess formation and keeps the tract clean.
- Reduces inflammation — A draining seton lowers swelling in the surrounding tissue, making future treatment easier.
- Buys time — It allows the surgeon to plan the right definitive procedure once the tract is stable.
- Works for complex cases — Especially effective for high, trans-sphincteric, and recurrent fistulas that cannot be handled with standard surgery.
The team at Kaizen Fistula Care has successfully managed hundreds of complex fistulas using seton placement as part of a staged treatment plan.
What to Expect During and After the Procedure?
The seton procedure is done under spinal or general anaesthesia. It is usually a day-care procedure — meaning you go home the same day.
The surgeon identifies the fistula tract, threads the seton through it, and secures it outside with a knot or clip. The procedure typically takes 30 to 60 minutes.
After the procedure:
- There will be some drainage from the tract — this is normal and expected
- Daily sitz baths (sitting in warm water) help keep the area clean
- Mild discomfort is common but manageable with pain medication
- A high-fibre diet and good hydration help bowel movements stay soft
- Regular follow-up visits are essential to monitor healing and adjust the seton if needed
Most patients return to light activity within a few days. Kaizen Fistula Care provides detailed post-procedure care instructions and scheduled follow-ups to ensure smooth recovery.
How Long Does a Seton Stay in Place?
This depends on the type of seton and how the patient heals.
A loose draining seton may stay in place for several weeks to months. It prepares the tract for the next stage of treatment. A cutting seton for a fistula is gradually tightened at every follow-up visit — typically every 2 to 4 weeks. The total duration can range from 6 weeks to 6 months, depending on the complexity of the fistula.
The surgeon monitors progress closely at every visit. At Kaizen Fistula Care, patients are guided at every step so they know exactly what is happening and what comes next.
Can a Seton Cure a Complex Fistula?
For simple fistulas, a cutting seton alone can sometimes achieve complete closure.
For complex fistulas, a seton is usually Stage 1 of a two-stage plan. The seton controls infection, reduces inflammation, and prepares the tract. Then a second definitive procedure — such as LIFT, FiLaC, advancement flap, or VAAFT — is done to close the fistula completely.
At Kaizen Fistula Care, Dr. Samrat Jankar offers the full range of sphincter-preserving surgeries. The most appropriate combination is planned based on your specific fistula type and health condition.
When Should You See a Fistula Specialist?
Do not ignore anal fistula symptoms. See a specialist if you have:
- Persistent pain or swelling near the anus
- Discharge of pus or blood near the anus
- A previous fistula surgery that has recurred
- A wound near the anus that is not healing
- Fistula with Crohn’s disease or IBD
Complex fistulas do not heal on their own. The longer you wait, the more complicated the tract becomes. Early specialist care makes treatment simpler, safer, and more effective. Kaizen Fistula Care is Pune’s dedicated fistula treatment centre led by Dr. Samrat Jankar — one of India’s most experienced fistula surgeons with 5,000+ successful anal fistula surgeries. The centre offers advanced seton procedures, laser treatments, LIFT, VAAFT, FiLaC, and all modern sphincter-preserving techniques under one roof.
Contact no – 9763635252 | 7558423708
Complex fistulas need expert hands. Do not delay. Reach out to Kaizen Fistula Care today and get the right treatment plan for your condition.
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