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Can a Seton do More Harm than Good

Hi,

Posting this question as it seems more subjective than objective.
I had a draining Seton placed last November and switched to Humira from Remicade. Since switching to Humira, I twice experienced an almost full healing of fistula which soon retrogressed to formation of a painful granulated tissue within a matter of 2-3 days (posted a different thread regarding this earlier).

I saw my Doctor yesterday and he felt that it is possible that the seton is irritating the tissue and in turn causing more harm than good at this time and it may be worthwhile to get it removed to see how I respond. His judgement was based on the two cycles of improvement followed by granulation, less or minimal drainage and also increased dosage of 6-MP (50 mg to 100 mg) since 2 months. He however said that he could be wrong and the worse case scenario would be to have to place the Seton again if the condition worsens.

He suggested me to see the surgeon and get his feedback as well who did not seem to be in a rush to remove it the last time I saw him ( a couple of weeks ago).

Any insights will be highly appreciated.
 
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nogutsnoglory

Moderator
The seton prevents it from fully closing. If you have no active infection draining and it's mostly closed up its worth getting the seton removed so it can fully heal. A sigmoidoscopy can be done in the surgeons office or a pelvic MRI can give better visualization.
 

Cat-a-Tonic

Super Moderator
Hi idlebrain, I've moved your thread to the Fistulas, Fissures and Abscesses section of the forum - hopefully you will get some good responses in here. :)
 

theOcean

Moderator
I also have a fistula and switched from Remicade to Humira. I felt that my fistula kept trying to close and the seton kept it open, and it would constantly irritate the tract and cause it to bleed. It caused a number of other discomforts for me, and after an MRI, I got it removed.

As long as you don't have any inflammation/infection it should be fine to get your seton out.
 
@theOcean: Thanks for your response. I had my blood work done and the results should be coming this week. Hopefully, they will confirm the assumption about lower inflammation levels and justify Seton removal like you indicate.

Also, just curious about your current state with respect to the fistula especially post Seton removal. Has it healed and did the Seton removal help?

ps: i just noticed that you actually started a separate thread to log your post Seton removal progress :). Will chk it out.
 

theOcean

Moderator
Oh! I was just about to link my thread, so that's great you found it. :p I've been trying to record my experiences there in the hopes they'd help others looking into it. It's definitely been a huuuuge improvement for me since I got it removed! No bleeding, no irritation, no pain...

The other important thing to make sure about is that you aren't getting any drainage before it's removed. Then you should be all right. :)

Mine hasn't closed yet, but I feel like it's getting closer to finally healing over all the time. It's been about two weeks since I got it removed, but I also had my seton in for about a year, so I feel like it might take a little time.
 
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