One of five fistula operations · see all techniques
Seton placement and staged fistula surgery: settling sepsis before the definitive operation
A seton is a soft surgical thread passed along the fistula tract and tied loosely, so pus drains and the inflamed tract settles into a clean, fibrosed tunnel. It is stage one for active sepsis, high, recurrent or horseshoe tracts; the definitive operation follows weeks later. Day-care; desk work in 2–5 days per stage (results vary). Performed by Dr. Kundan Kharde at Sharvari Hospital, Pimple Nilakh, Pune — 5 min from Wakad.
Who is this operation for?
The seton is the staged treatment row of Dr. Kharde's framework — recurrent, multiple or horseshoe tracts, or any tract with an undrained abscess or Crohn's disease. Operating definitively through infection is how fistulas recur and sphincter is lost; the seton settles sepsis first so LIFT, laser, VAAFT or fistulotomy can be done on a quiet tract. Almost every fistula at Sharvari Hospital is imaged before surgery — MRI fistulogram or trans-rectal ultrasound — and the tract on that scan decides the operation (how Dr. Kharde decides).
How is it done?
- Anaesthesia and examination. Spinal or short general anaesthesia; examination confirms the tract, branches and any pus pocket shown on the MRI.
- Drainage. Any abscess is opened and washed out; branches outside the sphincter are laid open.
- Passing the seton. A soft silicone loop is passed along the main tract with a probe.
- Tying loosely. Tied as a loose draining loop, so the tract stays open with no pressure on the sphincter.
- Stage two. After 6–12 weeks the matured tract is re-examined and the definitive operation chosen.
Stage one takes about 15–30 minutes · no sphincter is divided · the seton is removed at the definitive operation.
What does recovery look like?
| Day | Discharge & follow-up | Dressing & bowel movement | Return to work |
|---|---|---|---|
| Day 1 | Same-day discharge after observation; walking and normal diet that evening. | Light dressing; seton loop visible at the skin; cleaning routine taught; first bowel movement next day with a stool softener. | Rest at home; antibiotics and painkillers as prescribed. |
| Day 7 | Free first review at the hospital. | Twice-daily sitz baths; discharge along the seton is expected — that is its job. | Desk work from Day 2–5 (results vary). |
| Day 30 | Tract reviewed; stage-two date planned once it is quiet. | Discharge reduced; continence unchanged. | Normal work and light exercise with the seton in; gym after stage two. |
Same 30-day roadmap as the main fistula page. Results vary.
What are the risks and the alternatives?
- •Bleeding: minor spotting is usual; heavy bleeding is uncommon and is an emergency (we are open 24×7).
- •Infection: fever, rising pain or new swelling needs review; antibiotics are prescribed routinely.
- •Non-healing: a draining seton is not expected to close the tract on its own — it is a bridge to the definitive operation. Recurrence after the full staged plan depends on the definitive technique and on tract anatomy; results vary.
- •Continence change: very low risk with a loose draining seton — nothing is divided. Tight cutting setons carry real continence risk and are avoided for deep tracts.
- • Alternatives: Fistulotomy / fistulectomy, LIFT, FiLaC (laser), VAAFT — the imaging decides which.
Technique selection follows the ASCRS Clinical Practice Guideline for Anorectal Abscess, Fistula-in-Ano and Rectovaginal Fistula (2022).
How does Seton & staged surgery compare?
The seton row is different in kind: a first stage, not a cure — and it makes every other row safer when sepsis or a complex tract is present.
| Technique | Best for | Sphincter cut? | Day-care? | Typical return to desk work | Published healing range* | Recurrence risk |
|---|---|---|---|---|---|---|
| Fistulotomy / fistulectomy | Simple, superficial tract, <30% sphincter | Yes, minimal | Yes | 3–7 days | ~90–95% | Low |
| LIFT | Trans-sphincteric tract; intact sphincter needed | No | Yes | 5–10 days | ~60–80% | Moderate |
| FiLaC (laser) | Trans-sphincteric tract; patient wants no cut | No | Yes | 2–5 days | ~60–70% | Moderate |
| VAAFT | Complex / branched tract, unclear internal opening | No | Yes | 3–7 days | ~70–80% | Moderate |
| Seton (staged) (this page) | Active sepsis; high / recurrent / horseshoe; Crohn's | No (drainage) | Yes (stage 1) | 2–5 days per stage | Bridge to definitive operation | n/a |
*Published literature ranges, not Sharvari outcome data; results vary and depend on tract anatomy.
Why have it at Sharvari Hospital?
- ✓Routine pre-operative imaging — MRI fistulogram or trans-rectal ultrasound for almost every fistula.
- ✓Same surgeon consults and operates — Dr. Kundan Kharde, MS, FMAS, 19+ years, 6,000+ surgeries (Dr Kharde's fistula profile).
- ✓Our own 50-bed hospital, open 24×7 — in-house beds if anything needs observation.
- ✓Cashless with 50+ insurers — pre-authorisation by our TPA desk. ISO 9001:2015 · PCMC Reg. 884.
Frequently asked questions
Is a seton a treatment or a step? +
A step. A loose seton drains infection and turns an inflamed, branching tract into a quiet fibrous tunnel that a definitive operation can close. On its own it is not expected to cure the fistula, and it is not a sign of failure. Some Crohn's patients keep a long-term seton for symptom control.
How long does a seton stay in? +
Usually 6–12 weeks — long enough for the abscess to settle and the tract to mature, which is when LIFT or laser closure performs best. Recurrent or horseshoe tracts sometimes need longer; the interval is reviewed at each visit. The seton is removed at the definitive operation.
Cutting seton or loose seton — what is the difference? +
A loose (draining) seton is tied without tension and only drains. A cutting seton is tightened at intervals to slowly divide the muscle in its path. Cutting setons carry a meaningful continence risk and the ASCRS 2022 guideline advises caution; here a loose seton followed by a sphincter-preserving operation is preferred.
Why not do the definitive operation immediately? +
Because an infected, swollen tract cannot be closed reliably: sutures cut through, laser and LIFT fail, and a fistulotomy through swollen tissue divides more muscle than intended. Draining first costs a few weeks and gives the definitive operation a clean, mapped tract.
Does a seton hurt day to day? +
Most patients notice it for the first week and then mostly forget it. Some discharge onto a small pad is expected. Sitting, walking, office work and bathing are fine; the loop is cleaned during a sitz bath. Increasing pain or fever means it is not draining and needs review.
Cost, insurance and beds: see the full fistula treatment page.
Not sure this is your operation? Send the scan.
Dr. Kharde reviews your MRI report before you travel.
Request a call back
We call you back today.
Plan your fistula operation
WhatsApp your MRI — Dr. Kharde confirms which operation fits your tract.