Hi I'm new and I have a complicated fistula from an abscess that occurred in June of this year. I've never had any problems like this I'm 31 and otherwise healthy, no Crohn's no previous abscess, etc. Where it came from is quite the mystery but that was addressed and then the fistula was found because the incisions kept getting infected.... Once the fistula was diagnosed I had seton drains placed (August). Now on Wednesday I'm going in for a fistulotomy for one side of the track which is superficial, in addition to advance flap replacement on the other track which was much deeper.

No pain so far has been worse than the initial abscess, but I'm told this will probably be worse and that scares me to death. I was hospitalized after the abscess I&D for three days for infection and pain management. This procedure is to be done outpatient. So I have a few questions....

1. With the bowel prep for this, will I likely have to go the first day or two? It seems they clean you out pretty well then have prescribed liquids for two days post op as well. AND with the bowel movements....on a scale of 1-10 what are we talking about?? Just an opinion on this would help even if it's a 10 at least I know what to expect as the norm. With the I&D I had trouble "holding it" for a month then finally gained control again. Should I expect the same?
2. I have a month off of work for this. Will that be enough time or maybe too much time?
3. How long will I be "immobilized". Doctor says first 3 days you won't want to move. I've planned for my husband to be home to help for 5 days. Will that be enough? (We don't have kids just dogs and they have to be taken out and all that during the day if someone is home)
4. Aside from narcotic pain meds any other tips for making myself more comfy? Sitz baths of course but other than that?
5. Pre-surgery anxiety....how do you cope? I had a terrible anesthesia experience last time (was in twilight for seton placement, I stopped breathing had to be intubated and was hallucinating seeing my deceased father so I thought I had died) Needless to say I'm very nervous about going under again. Each time I have had something go wrong with breathing or they have had difficulty recovering me.

Any thoughts or insights are extremely welcome. Thanks for your time!

Hi Carrie,
Welcome here and sorry to hear about your situation & of your stress with it all.
I really can't offer you any insight on the advancement flap procedure because I had just a Fistulotomy, but I can reassure you that that part of the surgery is very straightforward, very quick & recovery is not lengthy.
I understand the flap is usually used in cases of a more complex fistula but there are other alternatives such as the LIFT procedure or glue/plug. Did your CRS discuss these options with you also and whether they are viable in your case?
I can only suggest you go back to your CRS armed with questions because it seems you may need a lot more information than you have already been given?
It would be good to compare success rates with the different procedures too.
Pre-op prep is normally eat as usual up until a certain time prior to the op (due to the effects of the GA) and then fast up until the surgery. You would then get the fleet enema about an hour prior to the op but I couldn't begin to guess what effects this & the post-op liquids would have - I'm guessing the intention is to keep everything pretty fluid to minimise stress on the area post-op....
From what I read, 3 weeks is generally the recommended bed recovery time but I guess it also depends on you as an individual and how the surgery progresses. I would give yourself more rather then less time to recover as you will probably require a lot of rest and will probably just want to sleep and make yourself comfortable. Certainly from the Fistulotomy side of things, you can be up and moving around pretty quickly. My CRS suggested about a week off work, but I actually felt OK & became pretty active pretty quickly. Of course, the Flap procedure may well lengthen that recovery and you will just need to take things day by day to see how strong you feel....
Aside from medication, lots of Sitz baths & nice hot baths to lie in too, you could try a heating pad or a nice cosy hot water bottle to relieve any discomfort down there....Best of all is always distraction, so I'd suggest getting in a collection of your favourite films, books etc. and just be as comfortable & as relaxed as possible watching funny films or engrossing yourself in books/ puzzles etc. to try & take your mind off things. Relaxation & meditation CDs could be really helpful in calming any anxiety and reinforcing positive imagery & techniques to help aid your recovery?
Pre-surgery anxiety is pretty much normal but given your history, I can understand why you are so scared. I would just ensure you have a good chat with your GP and surgeon pre-op to discuss all of this and your fear, because they will be able to reassure you...Just because that happened the first time does not mean to say it will happen all over again either, but do open up about your fears to anyone helping you through the procedure, even a friendly nurse or bedside neighbour - it will be better than bottling and working yourself up. Again, relaxation techniques can be great so it might be worth considering putting these into practice for some time prior to the surgery, just to try to bring your anxiety down. Self chat affirmations are also great for reinforcing positive thinking over negative or scary thoughts - so maybe work on your general anxiety beforehand??........
I wish you all the very best with this Carrie. The surgery is more complex but you are not alone because there are lots of others that do go through this too and come out very successfully in the end. Just stay strong, trust that this is helping you to become better & please come here anytime when you are feeling scared or stressed. Hopefully someone will come by soon with more knowledge on your particular procedure too. Take care and all the very best with your surgery.
Feel free to come by & update too.

Thanks for the input and encouraging words. There's actually no enemas for this bowel prep it's more similar to what you would have if you are having a colonoscopy. I've never had a colonoscopy but that's what I'm told. I'm just so nervous about going to the bathroom after and can only pray that I don't have to go the day of surgery lol. There's internal stitches involved in the flap replacement so I can only imagine what it's going to feel like. I will have a list of questions ready for my surgeon pre-op but we have indeed discussed the options and this is the best in his opinion though there are others.

Anxiety wise I'm getting worse every day I had a panic attack last night and actually called in sick to work today because I just couldn't deal. Luckily I have a lot to do over the next two days prior to surgery so I'm hoping that takes my mind off of it. I'm a nervous nelly anyway so this is nearly unbearable. I've got a great support system the problem is no one I know has ever had anything like this so it's difficult to relate. I'm really thankful you replied it makes me feel a lot better having some reassurance from someone who knows at least generally what I'm feeling. I'll check back in thanks!!

Carrie,
All the very best with your surgery tomorrow.
Try lots of deep breaths right from the bottom of your stomach to calm you down physically.
Hoping everything goes with no worries tomorrow & hey, you'll be another step closer to healed too!
Take Care & let us know how it all goes for you xx

Yes, good luck with your surgery tomorrow carrie.

Keep us posted on your recovery. Xxx

Thank you! Starting the dreaded bowel prep in one hour do no going back now ! I'll check in for sure thank you for the well wishes:-)

Good luck hope all goes well '

Good luck! Update when you have the strength!

Hope all goes well and a fast recovery

Quick update: went in yesterday for surgery and surgeon didn't show up there was some freak scheduling issue so he put me on for this morning (Thursday 11/14). Kind of a blessing in disguise I think for a few reasons. One my stomach was very upset still from the Miralax bowel prep. So I was still going to the bathroom in pre-op and I was concerned about being "cleaned out" enough. So that has become less of a concern I'm still on liquids and this scheduling error means I'll be on liquids an additional day BOO! Secondly, I feel much less anxious having had a trial run of sorts. The team at the hospital was very reassuring and hopefully I'll get the same anesthesiologist today. Today I'm looking forward to being the first patient of the day and just waking up a bit more peacefully this time. I know the pain will be terrible especially on the ride home as we have a 45 minute trip from the hospital, but I think once I'm home I'll be able to cope better with the idea of being in pain. That and being on home turf for bathroom issues is ALWAYS a blessing lol! Thanks again for all the well wishes....so nice to have a community of people who know the ropes and can sympathize. Update soon once feeling better