Seton fashioned from a Nelaton catheter and secured with nylon suture in the surgical treatment of Crohn's perianal fistula: technical note and case report.

Perianal fistula is a communication between the mucosa of the anal canal or distal rectum and the perianal skin. The treatment of perianal and rectovaginal fistulizing disease involves the use of antimicrobials, anti-inflammatories, but mainly a surgical approach. During surgery, anatomical elements and, when present, associated complications are identified. The external orifice(s) are enlarged, the path curettage and fistulotomy is performed. The extent of the fistulotomy is defined depending on the intensity of the inflammation, the presence and severity of the locoregional infection and mainly the amount of external sphincter muscle that will be sectioned. The device that repairs the path of the anal, anorectal or rectovaginal fistula is called a seton or sedon. This drain is just a variable segment of non-absorbable material inserted through one of the orifices and which runs along the fistulous path and exits into the other orifice. The ends of the seton are fixed in a variety of ways, usually through the creation of surgical knots with the drain itself or frequently through surgical knots with threads in the area juxtaposed to the drain. After closing the ends, the seton acquires the shape of a ring that is juxtaposed to the anatomical elements of the fistula. There is a description in the literature of the use of various products, the most common being sutures, elastic bands, probes and catheters. The objectives of seton in the surgical approach to the fistula are to keep the OI and OE open, allowing drainage of the tract and thus favoring the control of inflammation and infection, which allows the fistula tract to heal. The other objective is to bring the anatomical elements of the fistula closer to the anal verge.3,4 These functions of the setons are fundamental for controlling the damage in fistulizing perianal Crohn's disease. The purpose of the technical note The objective of this technical note is to describe the manufacture and location of the seton with the fixing system inserted into the lumen of the drain itself, using non-toxic material, of high resistance, good flexibility, low cost and easy access.