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Dig Surg. 2012;29(4):292-300. doi: 10.1159/000342398. Epub 2012 Aug 31.

Setons in the treatment of anal fistula: review of variations in materials and techniques.

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Department of Surgery, Providence Hospital and Medical Centers, Southfield, MI 48075, USA.



Anorectal fistulas have been a common surgical problem since ancient times. Age-old seton techniques are still practiced successfully in the treatment of complex anal fistulas. Many variations in materials and techniques are described in the literature. The selection of a seton type and technique depends on personal preferences. Our aim was to put together all the available variations in materials and techniques for seton treatment. This comprehensive review will help the surgeon to become more familiar with the various options available with regard to materials and techniques.


A review of the literature using Medline was done using the Key Words 'anal fistula' and 'seton'. All articles published in English were reviewed. The articles which had variations in materials and techniques for seton treatment were studied.


Various aspects of variations in materials, insertion techniques, maintenance of tension, mechanisms of action, drainage techniques and changing the seton have been elaborated in detail.


Throughout this paper we present the various available variations in setons with regard to materials, placement and maintenance techniques. This study will help clinicians in choosing a new seton variation or modifying their current method of treatment with setons.

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