4th surgery for Anal fistula, may need 5th. help

[Giblett]

I am so over these surgeries.  I just had my 4th surgery for a fistula and this one did not work. The Dr. did an extensive flap repair and stiched the flap over the tract. Went yesterday for follow up.  Infection settled in the flap area and he is talking about a seton placement. This surgery was one week ago. I am getting very depressed as he said the tract is way up in the rectum.  I have had the 4 surgeries in 4 months.  Can ANYONE help me with this or direct me to a web site for me to look at.
I don't want to spend the rest of my life dealing with this. Thank you

[PAJ]

Something for you to consider,
Botulinum Toxin for Anal Fissure

The toxin elaborated by Clostridium botulinum binds to the neuromuscular junction, preventing release of acetylcholine and thereby inducing profound paralysis. Injected locally in appropriate doses, however, this otherwise highly lethal substance has proved quite effective in treating a number of disorders manifested by intense muscle spasm (see "Botulinum Toxin: Potent Poison, Potent Medicine" by Lance L. Simpson).
Chronic anal fissure is a common disorder involving spasm of the internal anal sphincter. The aim of treatment is to reduce the hypertonia, which can be accomplished by lateral internal sphincterotomy. However, that procedure may cause minor but permanent alterations in rectal continence. An alternative approach has been local application of botulinum toxin or nitroglycerin ointment, with a view to effecting a medical sphincterotomy.
Investigators at the Catholic University of Rome have conducted a randomized trial of these medical interventions. Fifty consecutive adult patients with chronic anal fissure were randomly assigned to receive either 20 units of botulinum toxin (as a single injection into the internal anal sphincter) or 0.2% nitroglycerin ointment (as a 6-wk course of twice-daily applications to the anus and anal canal). Patients with acute fissure or in whom fissure was a complication of other medical conditions were excluded.
After two months, the fissure was healed in 24 (96%) of the toxin-treated patients and 15 (60%) of the nitroglycerin recipients (p=.005). Nine treatment failures in the nitroglycerin group and one toxin failure were crossed over to the other therapy, which resulted in healing. There were no complications of botulinum toxin. In contrast, five nitroglycerin-treated patients complained of headaches.
Brisinda G et al: A comparison of injections of botulinum toxin and topical nitroglycerin ointment for the treatment of chronic anal fissure. N Engl J Med 341:65, 1999; Hallett M: One man's poison--clinical application of botulinum toxin (editorial). Ibid:118
COMMENT: The U.S. Food and Drug Administration has approved botulinum toxin A for treatment of strabismus, blepharospasm, and hemifacial spasm. In these conditions, the injections must be repeated because their effects wear off within months. The nice thing about botulinum therapy of chronic anal fissure is that complete healing occurs after only one injection. In this vulnerable area, that sits better with me than even minor surgery.

[kimbacat]

I am really sorry to hear this.  did you have a seton placed before?  were the other surgeries fistulotomies?  was infection or re-abscessing the reason for recurrance?  did they culture each infection?  I think I remember you saying that they ruled out Crohn's disease, right?  with 4 surgeries in 4 months, I think I'd go with the seton to give the area time to heal and sort things out.  I'm guessing that you've been on anti-biotics the whole time and are doing sitz baths and using stool softeners.  the sitz baths are what helped ease the pain the most for me.  oh, and if you don't have any packing anymore, but still need to cover the external opening because of drainage, I found the non-stick gauze pads to be gentler than regular guaze or pantiliners.  there are more extensive surgeries that can be done, using thigh muscles, etc.  

the fibrin glue results have been pretty good, I hear.  results of usage were reported recently.  you might want to check out the american society of colorectal surgeons at fascrs.org  I'd bet they have a summary of the info, maybe from thier annual meeting.  

best of luck to you

[Giblett]

No, I have not had a seton placed, or a fistulectomy, or fistulotomy.  Mine started with an abcess.  Then one doctor went in to tear away some muscle.  In the meantime, I sought a second opinion by a colorectal specialist. 4 weeks after the second surgery, I had emergency surgery because I started bleeding and my white count was 18. He also put in a drain tube.  That stayed in for 2 months. Had another surgery last Friday to remove the tube and he did a large advancement flap.  Stayed in the hospital another 3 days on I.V. antibiotics.  Yes, I have been on antibiotics for some time now. Tequin. So, after my visit this friday, he said I had an infection, opened up where the drain tube was, again,and said he still saw the fistula tract. I go back Monday to get rechecked.  Possible Seton placed. Now you see why I am so depressed.  Nothing has worked.  He has talked about the glue, but I don't know what is next.  Will I ever get over this. And if I have the fistulectomy, he said I might risk being incontinent.  This is the worse case he has ever seen.  I am just wondering if the first doctor messed up and did not know what he was doing.  He should have helped me when he drained the cyst.  Right?

[kimbacat]

fistulas are unbelievable scarey things.  I'm really sorry you are having problems resolving yours.  it sounds like so far, you've had procedures done to incise and drain the abscess and then most recently had a flap repair done.  getting the abscess incised and drained was the right thing to do.  but there is always the risk of fistula development.  incontinence can be a result of a fistulectomy.  a lot depends on how much of the spincter muscle is damaged or scarred by the infection and healing process.  in some situations, a ceton can result in incontinence too.  but a ceton might help you until your infection is throroughly resolved.  because nothing is going to heal well if you keep getting infections.  

if your surgeon is saying this is the worst he's seen, you might want to consider finding another surgeon that has more experience with fistula repair.  is there a large teaching hospital in your area?  or a colorectal surgeon that 'specializes' in perianal Crohn's disease?  those would be your best bet because they would be the ones that have seen and dealt with a lot of complicated fistulas.

good luck, I hope the doc sees some positive changes at your visit tomorrow.

[Giblett]

Thank you so much for your replies.  I WILL post tomorrow and let you know how my office visit went.  I appreciate you and your concerns.  It helps to know some one cares.  If he states he wants to do surgery AGAIN, I will let you know.  Wish me Luck!

[arlmon]

Two years ago, my daughter had a fissurectomy - they anal muscle was cut. It was done with a local. She suffered so much before she had this procedure done. Not that it wasn't painful after - it was. But it got better after time. She also used nitrogyclerine ointment and this was helpful as well. Are you going to see a colorectal surgeon? That's the only surgeon I would recommend, because they are very experienced in this field. Good luck!

[Giblett]

Yes, I am seeing a colorectal surgeon.  The best in my area. sorry about your daughter.  I know they can hurt. i will know more tomorrow about my 5th surgery. My doctor thinks that I got this from a spider bite on my rear while painting my home. I have  been dealing with this for 6 months. And don't you know it is getting old. Just want my life back.

[midsummer]

I have suffered from anal fissures for 7 years. At the last count I had 4.
I had an anal stretch initially but this did not work and was then admitted for a sphincterotomy. When I was given the full version of the operation and the risks I decided at the last moment not to have it. I have other health issues and did not want to end up with an incontinence problem as well.
I was given the 0.2% ointment which was excellent but always had problems when I went to collect the presciption as it had been made out as 2% every time so I gave up in the end.
I do need to get the problem sorted out and would consider Botox as an option.
I was told by the Consultant that the more fissures you have the tighter the muscle becomes as the brain sees this as a way of protecting the area from more damage.....unfortunatley then the straining gets worse and then more fissures......so a no win situation.
You all have my sympathy I know what you are going through.

[Giblett]

An update from my doctors appt.  He found some infection, not as much as last Friday.  He wants to see me on Thursday and he put me on flagyl.  If I am not better by then, I will have surgery for a Seton placement under IV sedation.  Hopefully, it will be an out patient.  Wish me luck for Thursday.  I will let you know.
Thanks

[midsummer]

Good luck and let us know what exactly happens and how you get on.

[SweetCin]

I feel for you. I myself am about to undergo fibrin glue surgery on January 16th (my third surgery for anal/vaginal fistula). I've had two flap failures, and am frustrated like you. But wanted to reassure you about the seton placement, because I just had this done two weeks ago. The procedure itself wasn't bad. The shots were the most painful, but if you have a good surgeon, he'll go slow and massage the area. Just remember, it's not the needle that stings, it's the medicine. After the first few shots I didn't feel the rest of them, nor did I feel anything else. Take some pain medicine as soon as you can after the surgery (ask your doctor - depending on the sedatives they give you). I was in moderate pain directly after the sedatives wore off. It's not too bad if you can take pain medication and just go to sleep. The seton took a little getting used to, but it's not even been two weeks and I'm not even bothered by it.

[Giblett]

Could you please give me more details on this seton placement. I did not know there were needles involved, or did you do this in his office.  I will be put under I.V. anesthesia as an outpatient. Geez, needles. He said I had to go back once a week after it is placed to tighten it.  What is involved in that? He talked to me about the glue.  He said it doesn't work for most people. Seems like I am running out of options here if the seton doesn't work. My last resort is a Fistulectomy and I don't want that yet. The risk of being incontinent is my fear. It scares me to know that I could soil my pants and not know it. I am too active for this.  I am a bad patient because I am a nurse and I expect miracles.  you do not know how much "patience" I have learned with this problem. And this is the word my doctor uses. Patience. He must have made a fortune just on my rearend. Well, I go tomorrow for a check up to see if the flap finally worked.  If not, I will go Friday for my surgery for the Seton. I will be glad when I can finally get on with my life. Please let me know about the Seton thing. Thanks so much!

[Giblett]

Oh, by the way, I forgot to ask.  Why are you having the glue if you just had the seton.. Did that not work?  Or is this extra precaution to fix this problem? Thanks

[kimbacat]

good luck tomorrow Giblett.  sometimes seton placement is done using local anesthetic and sedation.  but sometimes the doc wants to do a thorough evaluation and explore the fistula tract and maybe clean it out a little.  that requires a general anesthesia.  well, I've heard of a few people that have endured that without sedation or general anesthesia thanks to a particularly uncaring surgeon.  my motto has always been.... "knock me out and wake me up when it's over".

actually, I'm trying to schedule an MRI of my pelvis to look for possible abscess/fistula development....... again.

[Giblett]

Your kidding.  Another one. Geez, what in the world is causing these? I feel for you also.  I know how frustrating this is for you. I don't think I could take a local for the seton placement. knock me out too!
Thank you for your concern.  It is good to talk to people about this and know they understand what you are going through. Do you have any idea how you got yours? you would think they would go in and close this shut so nothing could get in there. But, I know the end result, fistulectomy.  And I want to avoid that if at all possible. Good Luck Kimbcat.  My prayers are with you.

[kimbacat]

thanks!  I really appreciate the kind thoughts.  

I've had quite a bit of perianal Crohn's disease (an inflammatory bowel disease).  fistulas, abscesses, fissures, etc are complications of the disease.  recently, I've been getting fissures around my labia and perineum and I've been having a lot of pressure from inside my pelvis pressing out.  I have a permanent ileostomy, so no rectum.  doc felt some fullness in the area upon exam, but can't tell if it's just scar tissue from prior surgeries or not.  I've also been getting a lot of infections due to the medications I'm on.  so he wants an MRI to check everything out, since MRIs are better than CT and ultrasound at finding fistulas.

[Giblett]

I am so sorry.  I did not know it was this bad. God, and I have been complaining. I really feel bad for you.  I sure hope your test come out o.k. I am going to put you on my prayer list. Makes you wonder why, doesn't it. But I realize how many people I can help just by talking to them.  And you have helped me alot.
Blessings to you!

[Giblett]

Went to the doctor today.  He wants to wait until next Thursday before doing anything else.  He said I had some infection but it is looking good. so, The news of not having surgery tomorrow was a blessing to me.  will keep you all posted.

[kimbacat]

good to hear!!!!  moving in the right direction.  take it easy, tho, ok?

[Cheryl74]

Hi, I am new here, I just was surfing and found this website. I wanted to share what I have been through in the past month.

I went to my GYN because I had an anorectal abscess. He sent me to a surgeon and it was cut and drained in his office. It was horribly painful.

After 12 days, I still had draining and some pain. My doctor found that I had an anal fistula and I needed surgery to fix this. I had my surgery almost 3 weeks ago now. I went to see him for a followup and he said it is healing the way its supposed to and he wants to see me in another 2 weeks. This was almost a week ago now.

I am doing OK, but I am still not comfortable all the way. I still have some swelling down there but most of the drainage is gone away. Its starting to close up. He said its healing from the inside out.

I am a 29 year old woman who never has health problems. This whole experience has freaked me out to tears. My quality of life has not been too good over the past month and yet I am still not feeling the greatest. I am in total fear that something is still wrong even though my doctor looked at it a week ago and said its doing well. I just wanted to share my story because it seems like some of you KNOW what I am going through because NOONE in my family or friends has a clue here as to how I feel.

I have been so depressed about this. Its been a month and its constantly there. Anyone that wants to comment I would greatly appreciate the support here. I hope and pray every day this goes away and that I am well again soon.

[silk]

Hello, just wanted to say I though I had it bad, my heart goes out to you all. I wanted to pass along, that I too have had 4 to 5 surgeries and my last one my doctor, who is a colonrectal doctor, who listen, takes time to explain everything, also his staff. My last surgery, a Seton Placement was inserted, and althrough it has been in for two years now, and I have not any more lumps or boils come up, just every month I go in to have the seton tighten, now afterwards, it's sore, but nothing a little pain medicine can't take care of. At every visit to the doctor I'm asking when will the seton be removed, but reading someone else pain, last night I thought about the different things that you were going though and maybe I should let it stay in as long as possible. So just try the Seton

[silk]

Hello, just wanted to say I though I had it bad, my heart goes out to you all. I wanted to pass along, that I too have had 4 to 5 surgeries and my last one my doctor, who is a colonrectal doctor, who listen, takes time to explain everything, also his staff. My last surgery, a Seton Placement was inserted, and althrough it has been in for two years now, and I have not any more lumps or boils come up, just every month I go in to have the seton tighten, now afterwards, it's sore, but nothing a little pain medicine can't take care of. At every visit to the doctor I'm asking when will the seton be removed, but reading someone else pain, last night I thought about the different things that you were going though and maybe I should let it stay in as long as possible. So just try the Seton

[silk]

Hello, just wanted to say I though I had it bad, my heart goes out to you all. I wanted to pass along, that I too have had 4 to 5 surgeries and my last one my doctor, who is a colonrectal doctor, who listen, takes time to explain everything, also his staff. My last surgery, a Seton Placement was inserted, and althrough it has been in for two years now, and I have not any more lumps or boils come up, just every month I go in to have the seton tighten, now afterwards, it's sore, but nothing a little pain medicine can't take care of. At every visit to the doctor I'm asking when will the seton be removed, but reading someone else pain, last night I thought about the different things that you were going though and maybe I should let it stay in as long as possible. So just try the Seton

[silk]

Hello, just wanted to say I though I had it bad, my heart goes out to you all. I wanted to pass along, that I too have had 4 to 5 surgeries and my last one my doctor, who is a colonrectal doctor, who listen, takes time to explain everything, also his staff. My last surgery, a Seton Placement was inserted, and althrough it has been in for two years now, and I have not any more lumps or boils come up, just every month I go in to have the seton tighten, now afterwards, it's sore, but nothing a little pain medicine can't take care of. At every visit to the doctor I'm asking when will the seton be removed, but reading someone else pain, last night I thought about the different things that you were going though and maybe I should let it stay in as long as possible. So just try the Seton