Anal Fistula- Surgery Progression, Timeframe?

[redswingline]

I have a fistula that resulted from a perianal abscess that I had in June 2010.  It was finally diagnosed as a fistula in December 2010, and I've been seeing the colorectal surgeon who diagnosed it since then. The tract opening is adjacent to my vagina, which is awesome.

So far I've had three surgeries: 1) draining seton placement (January 2011), 2) fistula plug placement (March 2011), and 3) another draining seton placement (October 2011).  The plug didn't work completely- apparently it had filled most of the fistula tract, but not all of it.  My doctor thought that the continued drainage could have just been the last bit of the tract filling up, and if she curetted around the fistula opening, then we'd be all set.  But no dice.

Now I'm scheduled for an ultrasound to see how much sphincter muscle is affected by the tract.  Depending on the answer, she is thinking of the following procedures: LIFT, cutting seton, or fistulotomy, which apparently all carry risk of incontinence.  Given that I have not yet had any children, my doctor is concerned with a) not compromising my entire perineum pre-childbirth, and b) incontinence.  My doctor said that if I'd already had kids, she'd try the plug again.  I'm not sure why she wouldn't try again now.

I am thinking of getting a second opinion just to see if someone would try the plug again and/or agree with her assessment.  If I don't have to worry about incontinence in 20 years, I'd prefer not to.

Has anyone else had a fistula like mine?  How long/how many surgeries did it take to heal?  Are you incontinent?  How much?  If you're a lady, did you have kids afterward?  How did that go?  I know every body is different, but I am tired of wearing mini pads every day, and I'd like to get my life back.

Anyone have recommendations for colorectal surgeons in Chicago?

[shoaibrony]

Very nice to hear from you that the operation went succesfull and you are bak to your normal life again

[jay69580]

You please visit the website www.joedelivera.com/ which gives homeopathic solutions for the treatment of Fistula.

[redswingline]

I feel like I should post an update here since I started the thread.  

I did go for a second opinion in December, and he suggested the same procedures that my doctor planned, so I stuck with her.  (Both colo-rectal specialists- I never saw a general surgeon.)  The procedures were a LIFT and advancement flap, and she planned a hybrid procedure.  

I had the procedure in January, and it turned out I wasn't a good candidate for LIFT, so they did an advancement flap.  It hurt like a mother for about two weeks, but I started to feel a lot better in the third week.  I stayed home from work for a week immediately post-surgery, and had to be pretty immobile/horizontal.  I probably should have taken two weeks off, because the first week back was pretty uncomfortable.  I was walking around a couple of days after surgery, but it was not without pain, so I didn't do much of that.  It was a challenge being on narcotic painkillers, which are constipating, trying to counter act the effects with fiber supplements and being really careful with my eating.  I had many pains in the a$$.

It's been 4 weeks today, and I'm back to my normal routine, including running.  I went for a check up after two weeks, and my doc said everything looked like it was healing as expected and the tract is gone from inside my anal canal.  The outside opening near my vagina is healing pretty well (and quickly)- I still have to wear mini pads to catch all of the mucus from healing, but I think that won't be for too much longer.  I see her again on Friday.

In the last week I've passed gas a couple of times without being able to control it, but it wasn't loud/didn't smell, so I was in the clear.  It also helped that we were at a friends house where farts and poop jokes are commonplace.

I am optimistic that we're near the end.  As much as I really like my doctor, I'm looking forward to not having to see her.

[saskiamom]

I feel like I'm reading my own story here. I just returned front the doctors office and will be having the LIFT procedure done after having a failed plug surgery (now have 2 setons placed.) If you don't mind, can you tell how your LIFT procedure went, are you healed now? How was recovery?

[jackal907]

I am having a LIFT procedure on Friday.
I highly recommend seeing a colorectal specialist, not a general surgeon.  From the research I have done and from what my surgeon has told me, the plugs have very little success and she only uses them when patients demand them and she has never had a successful plug surgery.  Fistulotomy sounds barbaric and has not changed much in a hundred years, but that is because the procedure works.

I have the exact same cyst/fistula situation as you.  It was lanced and drained in August 2011, never healed and went in for a fistulotomy in November and it was found to have multiple tracts intersecting my internal sphincter muscles, so two Setons were placed.  Friday she will ligate the tract (LIFT) and then we wait to see if the tract closes and if it does there is a chance it can reappear and you do the whole thing over again.

So far I haven't had any incontinence issues.  I was back to work in 2 days from the Seton procedure, but wish I knew what to expect with the LIFT procedure.

[patient915]

Welcome to the gastroenterology community!  I agree with you that a second opinion sounds like a good idea.  I hope someone that can answer your other questions will come along.  Good luck.