How to Insert a Draining Seton Correctly

INTRODUCTION: Misconceptions exist about the proper way to use draining setons in the management of anal fistulas. This technical note lays out the principles for their use. TECHNIQUE: Insertion of draining setons is a prerequisite to successful management of anal fistulas. The correct technique involves identification of the correct track and internal opening and drainage of the track with a silastic seton. This sets the stage for definitive repair after the inflammation subsides. RESULTS: Three cases are presented to illustrate common errors made during the insertion of draining setons. CONCLUSIONS: Appropriate seton drainage of an anorectal fistula is an important part of the ultimate repair. Correct use of setons minimizes symptoms from the seton itself and optimizes its effectiveness.