Seton Placement
What is Seton Placement?
Seton placement is a surgical procedure used in the management of anal fistulas, particularly complex or high fistulas, where a seton (a thread-like material) is inserted through the fistula tract to promote drainage, control infection, and either prepare for definitive surgery or maintain long-term management without cutting the anal sphincter. This sphincter-sparing technique helps reduce the risk of incontinence. In India, seton placement is performed in specialized colorectal surgery centers, offering affordable and effective care. For patients and families in India, understanding the procedure, costs, recovery, risks, and frequently asked questions (FAQs) is essential for informed decision-making and optimal outcomes.
Why do you need Seton Placement?
Seton placement is indicated for:
- Complex anal fistulas: Transsphincteric or suprasphincteric fistulas involving significant sphincter muscle, where fistulotomy risks incontinence.
- High fistulas: Fistulas above the dentate line, often associated with Crohn’s disease or recurrent disease.
- Recurrent fistulas: After failed prior surgeries.
- Active infection: To drain abscesses and control sepsis before definitive treatment (e.g., LIFT procedure or fistulotomy).
- Crohn’s disease: For long-term management of fistulas without cutting the sphincter.
The procedure aims to manage infection, promote healing, and preserve continence while planning further treatment if needed. In India, hospitals like Apollo, Fortis, Medanta, and AIIMS specialize in seton placement, often combining it with other fistula treatments.
Why Do Seton Placement Costs Vary in India?
Costs range from ₹20,000 to ₹1 lakh:
- Procedure Type: Standard seton placement (₹20,000–₹50,000); combined with abscess drainage or imaging (₹50,000–₹1 lakh).
- Hospital/Location: Higher in metro cities (Apollo, Fortis); lower in government hospitals (AIIMS, ₹5,000–₹30,000).
- Surgeon’s Expertise: Experienced colorectal surgeons charge more.
- Additional Costs: Diagnostics (MRI, ultrasound), anesthesia, medications.
- Insurance: Often covered for symptomatic fistulas; Ayushman Bharat offers subsidies.
Seton Placement Procedure
The procedure is typically performed as a day-care surgery:
- Before Surgery Evaluation:
- Diagnosis:
- Physical exam identifies the external opening, discharge, or abscess.
- Proctoscopy or sigmoidoscopy locates the internal opening.
- MRI or endoanal ultrasound maps the fistula tract, confirming its complexity and ruling out abscesses.
- Blood tests ensure surgical fitness, especially for patients with Crohn’s disease.
- Antibiotics (e.g., metronidazole) are given for active infection.
- Patients are counseled on seton care, potential discomfort, and the need for further surgery.
- Diagnosis:
- Surgical Techniques:
- Seton Placement with Drainage:
- Performed under general or spinal anesthesia, lasting 15–30 minutes.
- The patient is positioned in the lithotomy (legs raised) or prone position.
- A probe is inserted through the external opening to trace the fistula tract to the internal opening.
- Any associated abscess is drained, and the tract is cleaned to reduce infection.
- A seton (e.g., a rubber band, silk suture, or nylon thread) is passed through the tract and tied loosely to form a loop, ensuring continuous drainage.
- Types of Setons:
- Cutting Seton: Tightened gradually over weeks to slowly cut through the sphincter, minimizing incontinence risk (used less commonly due to discomfort).
- Draining Seton: Left in place long-term to maintain drainage, often for Crohn’s patients or as a bridge to definitive surgery (e.g., LIFT).
- The procedure is outpatient, with discharge within a few hours unless complications arise.
- Seton Placement with Drainage:
- After Surgery:
- Patients are monitored for a few hours for pain control and to ensure no immediate complications.
- Pain medications (e.g., paracetamol, ibuprofen) and sitz baths (warm water soaks) reduce discomfort.
- Antibiotics may be prescribed for 5–7 days if infection persists.
- Follow-up visits assess fistula drainage, seton position, and plan for further treatment.
Recovery After Seton Placement
- Hospital Stay: Outpatient; discharged within a few hours.
- Post-Surgery Care:
- Mild to moderate pain for 3–7 days, managed with painkillers and sitz baths 2–3 times daily.
- The anal area must be kept clean and dry; patients use wet wipes or shower after bowel movements.
- Antibiotics and stool softeners (e.g., lactulose) prevent infection and straining.
- Activity/Diet:
- Light activities resume in 1–2 days; strenuous activities (e.g., heavy lifting, sports) avoided for 1–2 weeks.
- High-fiber diet (fruits, vegetables, whole grains) and 2–3 liters of water daily promote soft stools.
- Avoid spicy foods or alcohol for 3–5 days to reduce irritation.
- Follow-Up:
- Visits at 1–2 weeks, 4–6 weeks, and as needed.
- Draining setons may remain for months; cutting setons are tightened every 2–4 weeks until the tract heals.
Most resume normal activities in 3–7 days. Setons control infection in 80–90% of cases, but definitive fistula closure often requires additional surgery (e.g., LIFT, 70–90% success).
Risks and Complications
- Surgical Risks: Bleeding, infection at the seton site.
- Seton-Related Issues: Discomfort, irritation, or seton displacement (rare, may require repositioning).
- General Risks: Anesthesia reactions.
- Long-Term: Persistent fistula (if untreated), minor incontinence (1–5% with cutting setons), recurrence (10–30% without further surgery).
- Report fever, severe pain, or seton issues promptly.
Frequently Asked Questions (FAQs)
What causes anal fistulas requiring seton placement?
Infected anal glands, often complicated by Crohn’s disease, recurrence, or high tracts.
Is seton placement a permanent solution?
Draining setons manage infection but don’t close the fistula; further surgery (e.g., LIFT) is often needed. Cutting setons may heal the tract over time.
Does it hurt to have a seton?
Mild discomfort for 3–7 days; sitz baths and painkillers help.
How soon can I resume activities?
Light activities in 1–2 days; normal routines in 3–7 days.
Is seton placement covered by insurance in India?
Yes, for symptomatic fistulas; confirm with your provider.
Signs of complications?
Fever, severe pain, seton displacement, or increased discharge.
Can fistulas recur after seton placement?
Yes, 10–30% risk without definitive surgery; recurrence is higher in Crohn’s patients.
Lifestyle changes post-procedure?
Maintain hygiene, high-fiber diet, avoid straining, and follow up for further treatment.
Conclusion
Seton placement is a safe, sphincter-sparing procedure to manage complex anal fistulas, controlling infection and preparing for definitive treatment. India’s top hospitals (Apollo, Fortis, AIIMS) offer affordable, high-quality care. Understanding the procedure, costs, recovery, risks, and FAQs helps patients approach seton placement confidently. Consult a colorectal surgeon for personalized guidance and successful management.
Looking for Best Hospitals for Seton placement
Note: we are not promoting any hospitals
we are not promoting any hospitals we sourced all the details from google and hospitals website, please verify and start with your surgery here we go the list includes government, budget and superspeciality hospitals accreditation bodies are the National Accreditation Board for Hospitals and Healthcare Providers (NABH) and the Joint Commission International (JCI)
- click on your city and schedule your surgery now done in good hands.
| City | Minimum Price (₹) | Maximum Price (₹) |
|---|---|---|
Agra |
20,000 |
70,000 |
Ahmedabad |
25,000 |
80,000 |
Ajmer |
20,000 |
70,000 |
Aligarh |
20,000 |
70,000 |
Allahabad |
20,000 |
70,000 |
Amritsar |
22,000 |
75,000 |
Aurangabad |
22,000 |
75,000 |
Bangalore |
25,000 |
80,000 |
Bareilly |
20,000 |
70,000 |
Belgaum |
22,000 |
75,000 |
Bhopal |
22,000 |
75,000 |
Bhubaneswar |
22,000 |
75,000 |
Bikaner |
20,000 |
70,000 |
Chandigarh |
25,000 |
80,000 |
Chennai |
25,000 |
80,000 |
Coimbatore |
25,000 |
80,000 |
Dehradun |
22,000 |
75,000 |
Delhi |
25,000 |
80,000 |
Dhanbad |
20,000 |
70,000 |
Durgapur |
20,000 |
20,000 |
Faridabad |
25,000 |
80,000 |
Ghaziabad |
25,000 |
80,000 |
Gorakhpur |
20,000 |
70,000 |
Guntur |
22,000 |
75,000 |
Gurgaon |
25,000 |
80,000 |
Guwahati |
22,000 |
75,000 |
Gwalior |
20,000 |
70,000 |
Hyderabad |
25,000 |
80,000 |
Indore |
22,000 |
75,000 |
Jabalpur |
20,000 |
70,000 |
Jaipur |
25,000 |
80,000 |
Jalandhar |
22,000 |
75,000 |
Jamshedpur |
22,000 |
75,000 |
Jodhpur |
20,000 |
70,000 |
Kanpur |
20,000 |
70,000 |
Kochi |
25,000 |
80,000 |
Kolkata |
25,000 |
80,000 |
Kollam |
22,000 |
75,000 |
Lucknow |
22,000 |
75,000 |
Ludhiana |
25,000 |
80,000 |
Madurai |
22,000 |
75,000 |
Mangalore |
22,000 |
75,000 |
Meerut |
20,000 |
70,000 |
Moradabad |
20,000 |
70,000 |
Mumbai |
25,000 |
80,000 |
Mysore |
25,000 |
80,000 |
Nagpur |
22,000 |
75,000 |
Nashik |
22,000 |
75,000 |
Navi Mumbai |
25,000 |
80,000 |
Noida |
25,000 |
80,000 |
Patna |
20,000 |
70,000 |
Pune |
25,000 |
80,000 |
Raipur |
22,000 |
75,000 |
Rajkot |
22,000 |
75,000 |
Ranchi |
20,000 |
70,000 |
Surat |
25,000 |
80,000 |
Thane |
25,000 |
80,000 |
Vadodara |
22,000 |
75,000 |
Varanasi |
20,000 |
70,000 |
Visakhapatnam |
22,000 |
75,000 |
Disclaimer
This information is sourced from open platforms and is for general awareness only. Costs may vary based on individual cases. Please consult a qualified doctor for medical advice and explore options within your budget before deciding on the procedure.