Need Advice on whether to do fistulotomy or not

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Need Advice on whether to do fistulotomy or not

Postby lordtrinity » 09 Nov 2012, 00:47

Hi All,
This is my first post to this forum and I am glad I found it since I have been sort of in dark. It is nice to know there is such a good support forum to discuss the somewhat "difficult" topics that are at times difficult to discuss even with the doctor.
I wanted an opinion on whether I should get a fistulotomy surgery done or not. 3 yrs ago I had an anal fissure develop (long term constipation and hard stool problem). The fissure did not heal despite trying nifedine cream and 3 botox injections but perhaps a benefit of botox injection was that the pain, itching and other symptoms pretty much went away. The fissure created a large skin tag and few months ago I noticed pus discharge, ithching and pain in the skin tag. The pain has subsided now but the discharge (sometimes yellow, sometimes pink and sometimes fresh red blood) continues with some itching and discomfort. The CRS says it is a fissure fistula (and a second CRS I saw for second opinion said "superficial fistula") and both said that the only way to treat it is fistulotomy. Now, I am in double mind if this should be done or not given the risks and especially since I am pain free. The only symptom is periodic discharge. They also said that my anal muscles are very tight and I am prone to fissure all my life. Given that I am concerned that healing of wound due to fistulotomy might be difficult since the muscles are tight and I experience muscle spasms from time to time.
My question is what are the risks of leaving the fistula as it is given that there is mainly dischange and no pain. Is it worth it to go through all the pain and attendant risks of the surgery? I am concerned if I will end up with more problems after the surgery than before. The discharge and minor irritation etc. is not pleasant but I have adjusted to it now and take consolation in the fact that I am pain free (normal and even during bowel movements).
sorry for the long message and thank you for your advice.
thanks a lot.
Male 45 yrs old
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Re: Need Advice on whether to do fistulotomy or not

Postby Ever the Optimist » 09 Nov 2012, 13:23

Hi!
Gosh, you do have a decision to make based on the experience you have had. Image
On the one hand, I can understand totally why you would prefer to forget the surgical intervention and leave the fistula alone and leave things as they are because you are pain free and feel normal, but on the otherhand, a fistula will not go away without the surgical intervention and over time, there is also the possibility that it can grow or develop further tracts and you don't want the risk of that happening either, which in turn, could cause you further complications.
I would suggest maybe go back with all your worries and fears given your history and get some thorough answers and reassurance to your queries.
I had a fissure, which was healing when my fistula appeared and was using Dilitazem at the time to treat the fissure.
I still opted for the Fistulomy because I just didn't want it there. It also didn't cause me much pain and I was suffering only with the discharge stuff but nevertheless, I wanted it sorted (but that's me!) Also my fistula was totally unrelated to the fissure and in a completely different area, so I didn't have to worry about that connection like you.
The procedure for a Fistulomy is very different to treating a Fissure but also highly effective and successful in removing it when treated properly. It could be that you have nothing to fear and surgery will deal with it without causing further problems with the fissure. I believe that sometimes the creams are prescribed to people dealing with Fistula recovery but still suffering the ails of a fissure to relieve the muscle spasms in the anal area and aid the general healing process, but you really would need to go back and ask the questions to get that confirmation and go from there.
Truly all the best to you in whatever you decision you make but get some more medical reassurance on those existing worries that you have. Hoping it all works out for you and you make that decision soon. :)
Chronic Fissure diagnosed December 2011
Healed by Diltiazem around Feb 2013
Anal Fistula followed burst abscess in June 2012
2 internal troublesome piles remain & suspected, but undiagnosed, ongoing Levator Ani type symptoms & flare-ups
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Re: Need Advice on whether to do fistulotomy or not

Postby lordtrinity » 09 Nov 2012, 23:31

Hi Ever-the_optimist,
thank you very much for for reply and advice. Really appreciate it. I will go back and discuss my concerns with the surgeon.
How was your experience with fistulotomy?
How long was the recovery and how long when you got back to normal activities.
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Re: Need Advice on whether to do fistulotomy or not

Postby ZeeZee » 10 Nov 2012, 05:24

Hello Trinity, my advice, do the surgery as soon as possible.. Consider the facts, it's NOT going to heal on its own..
It can ONLY get worse and whn tht happens, your 'downtime' increases.. Remove it while it's still small and NOT infected..
I'm not just speaking, I have had the experience of having two removed.. One was very infected, like you, I wondered abt surgery.. If I could go back, I would have done it instantly..
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Re: Need Advice on whether to do fistulotomy or not

Postby lordtrinity » 12 Nov 2012, 00:54

Hi ZeeZee,
Much appreciate your advice. I have been reading your posts and am very glad to hear that you are recovering well and on the way to complete recovery. Thanks also for sharing all your experience.
The advice I have received so far from doctos and from ETO and yourself is everyone recommending to go ahead with the surgery. I am also now leaning towards it but am certainly scared about it and the post-op recovery.
But I guess, there is no other choice as the fistula will not heal on itself and only become worse if left too long.
I will keep you guys posted.
best wishes.
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Re: Need Advice on whether to do fistulotomy or not

Postby lordtrinity » 14 Nov 2012, 11:50

Hi ZeeZee and ETO,
I have decided to go ahead with the fistulotomy ...I'd be kidding if I do not admit that I am scared. But I guess that is to be expected.
I have a few questions/advice from you guys:
- how did you prepare for the day before surgery? did you take enema or milk-of-magnesia (or similar laxative) was sufficient?
- when did the first BM happen after the surgery? next day or day afternext. What should I shoot for? right the next day (probably not feasible since nothing eaten on day of surgery) or day after.
- How long after surgery did you take a laxative and stool softener on a daily basis? These things have side effects.
I will read your posts also but greatly appreciate any advice.
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Re: Need Advice on whether to do fistulotomy or not

Postby Ever the Optimist » 14 Nov 2012, 13:24

Hiya,
I think you are making completely the right decision LT. ...A Fistula is very straightforward to treat especially if they deal with it early and it's superficial. Healing rates are very high and reoccurence, very very low. It'll be one thing less to worry about once you have it treated.....
I didn't do anything particularly different prior to surgery. I continued with my normal routine, didn't take any additional stool softener or have an enema. I wasn't advised to do any of those things and just had my normal morning BM the morning of the surgery, a good hot bath and clean up with shower head to make sure all was good and clean.
You aren't allowed to eat so many hours prior to the GA. My appointment was scheduled for 3.00 pm and I think the last time I was able to eat was before 7.00 am that morning and the last thing I could drink was about 10.00 am prior to the op.
When I came around after my op, I was starving!!! I ate a full hospital meal straight after (must have been starving!!) and a full dinner that evening. I don't mind the after-effects too much of the GA and the local anaesthetic they put into your bottom, because it actually provides a lot of relief for a few hours after.
Tbh, maybe I was lucky, I don't know - but my routine seemed to continue as normal. The day after, I had a normal morning BM with minimal discomfort and my routine continued as normal from then on....I think we all have very different experiences but I can honestly say, I didn't make a big deal of my surgery and it just seemed to fit into my day!
I did (and would) however recommend, that you continue with the stool softener whilst the healing process is under way because the area is still extremely delicate whilst healing and you need to be as stringent after, as before, to ensure that your BM's are Mr Whippy soft!! I took Lactulose twice daily and Olive Oil (tablespoon in the evening) to keep it all soft and lubricated. I had my op back in June and came off the Lactulose only 3 weeks ago as that's when I felt ready to do so and tbh, it's not been an issue as I think my diet is good and I'm getting my BM's nice and soft always now. Both Lactulose and Olive Oil are considered "safe" options to take and I won't stop the Olive Oil ever because it has all sorts of health benefits too. I've never used laxatives as I know these are not good for long-term use.
The main things during healing are:
Keep that diet "soft" and eat all the foods that promote soft as soft stools and drink loads of fluids for smooth evacuation!
Use a stool softener for as long as you feel the need.Do NOT strain!
Keep everything meticulously clean whilst healing to prevent any infection ( I have always sworn by the shower head after a BM and pat drying with towel)
Don't be afraid to take the pain killers if you need them - I was lucky, I took very few, but again it varies from person to person. Take them if you need them! Don't be "brave" just for the sake of it!
Try and get at least one week off work after your op. I had about 10 days off in total and went back after (but tbh, probably could have done with a bit more rest - but that's me!!)
I have a very detailed account if you go to 3 Days Post-Fistulomy in the "Surgery" section. It details everything from my original fissure, through to fistula development and treatment and updates regularly post op. I think, worth a read!
Keep us posted and feel free to come back with any more questions for reassurance and advice.
Take Care :)
Chronic Fissure diagnosed December 2011
Healed by Diltiazem around Feb 2013
Anal Fistula followed burst abscess in June 2012
2 internal troublesome piles remain & suspected, but undiagnosed, ongoing Levator Ani type symptoms & flare-ups
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Re: Need Advice on whether to do fistulotomy or not

Postby Ever the Optimist » 14 Nov 2012, 13:35

......and try not to be scared! It's REALLY and truly not that bad and a VERY simple procedure. Post op discomfort really isn't any worse than suffering with the fistula at its inflamed stage and no where near as bad as an acute fissure and all the pain you get with that........!
Chronic Fissure diagnosed December 2011
Healed by Diltiazem around Feb 2013
Anal Fistula followed burst abscess in June 2012
2 internal troublesome piles remain & suspected, but undiagnosed, ongoing Levator Ani type symptoms & flare-ups
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Re: Need Advice on whether to do fistulotomy or not

Postby Diamond » 14 Nov 2012, 15:27

LordTrinity - I'm actually glad you say that you've decided to go ahead with the fistulotomy. My advice would have been to have it taken care of.
I put my surgery off - not really because I wanted to, circumstances and wait-times just sort of worked out that way. I really wish it could have all been taken care of right at the beginning. I also figured my one fistula at the time wasn't giving me too many issues - so it was okay to just live with it? Anyway - fast forward 2 years and I got another abcess and was told it was probably due to a second tract. Fast forward 3 years - and I ended up with two fistulotomies and a seton placement. My surgeon told me I had a golf sized abcess and a lot of infection inside me - just wonderful! She was actually surprised as overall, I'm pretty healthy. My theory is if this had been taken care of back when it wasn't serious - it would probably all have been a lot simpler.
I agree with ETO - it's not really a gruesome procedure at all. Don't over-read into what you see online (I did!). I was back to working (from home) 10 days post-surgery, and back in the office after 2.5 weeks. I could have gone in after 10 days but just opted to take it a little easy as I work in a stressful environment.
Regarding your questions:
- I didn't have to take any laxatives or enema prior to my surgery either. I think this depends on how your surgeon likes to do things. My surgery was also in the afternoon - but I was advised not to eat/drink anything after midnight the night before. So, I had my dinner at about 11pm. The reason for this is so that you don't accidentally throw up while you're under GA.
- I actually had a bm the next morning. My bms continued to be normal for a couple of days - so I stopped taking the stool softeners and wasn't taking any laxatives. I was on percocet and that ended up constipating me really badly on day 3. I've never felt pain like that in my life - soo my recommendation would be to take both laxatives and stool softeners for those first few days after surgery, especially if you're on any super strong meds. Lots of water as well - I drank 10+ glasses per day. I stopped taking the laxatives and stool softeners about 1 week after surgery. I also weaned myself off the pain meds about 2 weeks after surgery. Overall, it wasn't painful - just the packing changes were bad as I had one very deep wound.
If your fistula is "superficial" - it's good you're getting it taken care of. Recovery will not be too bad. My superficial one is now almost healed fully - 4 weeks post surgery. Also, I only had pain in that wound for 3-4 days post surgery.
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Re: Need Advice on whether to do fistulotomy or not

Postby lordtrinity » 14 Nov 2012, 20:58

Hi ETO and Diamond,
thanks you so much to both of you for the positive words just before I go for the surgery. I am actually more relaxed now after reading your accounts.
I will keep you all posted how it goes and the recovery.
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