Surgery or no surgery?

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Surgery or no surgery?

Postby Fraggle » 24 Mar 2017, 00:07

So glad I found this forum, I would really appreciate some advice.

I've been diagnosed with a suprasphincteric fistula, which was confirmed in a MRI, my CRS was very surprised about as I have no history of colorectal disease. I suspect it may have come about through infection which has somehow burrowed very deep, following small fissures.

CRS wants to do two procedures - the first to do a partial fistulotomy, which will leave me with a very large and deep wound, given the location of the fistula, convert the high fistula to a lower one and insert a seton. The second surgery would involve a fistulectomy and VAAFT repair with fibrin glue.

I'm really not sure whether to go ahead with the surgery. The fistula doesn't really bother me all that much. It's painful at times and the discharge is inconvenient and occasionally embarassing. The surgeries and the subsequent prolonged healing time period sound horrid from what I read on the various forums and it's probably going to mean a number of weeks off work. Do you think I should undergo the treatment or just live with the fistula?
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Re: Surgery or no surgery?

Postby zinnia » 26 Mar 2017, 17:43

Fraggie- I have no answers, but seem to be on a similar path- you can read what I just posted. Similar procedures have been mentioned. I hope to speak further w/surgeon tomorrow and I will share any info I get. He didn't seem too interested in my MRI report, but did not look at scan itself. The hard part is that they don't til they get in. This will be my second surgery in three months and a follow-up to one 25 year ago. Sending support!
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Re: Surgery or no surgery?

Postby Fraggle » 27 Mar 2017, 20:55

Hi Zinnia. Thanks for your support. Do keep us posted on what your surgeon says. I had to have the MRI because the CRS wasn't able to find the internal opening when he examined me, even with the anoscope. I think it is because the opening is so high. I've decided to go back and visit my CRS again with a list of questions, including whether there is any alternative treatment and to try and get a better understanding of how long it will take to recover, so if I do decide to go ahead with the surgery, I can try and schedule the procedures at the least disruptive time.

This is my second fistula, having had a perianal absess six years ago, which turned into a low fistula. That was also two surgeries in three months, but straightforward and I was pretty much healed around a month after each. Hopefully it will be same for you. Sending support to you too!
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Re: Surgery or no surgery?

Postby zinnia » 27 Mar 2017, 21:11

Fraggle- I had a fistulotomy 25 years ago! and then old abscessed (?) scar tissue removed from same area in January- but I think the opening healed like some abscesses do and a fistula has formed. I have a hard knot and so much discomfort. I am scheduled for a EUA and ultrasound April 7. The surgeon told me that MRI's don't always show openings- this after I had an MRI recommended by another surgeon and gastro. Did they find opening on yours? Crazy making. I hope it is low, but he suggests he found a dimpled area up high- I am hoping it is old scar tissue. He also suggested that it will prob be a seton.... Lets stay in touch for sure.
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Re: Surgery or no surgery?

Postby Fraggle » 03 Apr 2017, 07:34

zinnia wrote:Fraggle- I had a fistulotomy 25 years ago! and then old abscessed (?) scar tissue removed from same area in January- but I think the opening healed like some abscesses do and a fistula has formed. I have a hard knot and so much discomfort. I am scheduled for a EUA and ultrasound April 7. The surgeon told me that MRI's don't always show openings- this after I had an MRI recommended by another surgeon and gastro. Did they find opening on yours? Crazy making. I hope it is low, but he suggests he found a dimpled area up high- I am hoping it is old scar tissue. He also suggested that it will prob be a seton.... Lets stay in touch for sure.


My MRI did show an opening, but neither of the two CRS I have seen have been able to find it on visual inspection, probably because it is quite high. I went back to see the CRS today to ask a few more questions. He is adamant that a partial fistulotomy will heal in 2 to 3 weeks once he has cleared the infected tissue. My last fistulotomy did heal quickly, but it was not nearly as deep or as long as this one, so I am a bit sceptical. However, I have now agreed to go ahead with the first surgery on 4 May. First stage of procedure will be to find the internal opening under EUA, followed by partial fistulotomy and inserting a seton. I queried the need to do the partial fistulotomy but he explained that he has to do it so he can find out how much sphincter is involved and also to try and move the external opening nearer to my anus to make the second surgery easier.

He is now saying that the second procedure will be either fistulectomy/fistulotomy by VAAFT if there isn't too much sphincter involved, but otherwise it will the LIFT procedure, which is another reason I need the seton, as widening the tract is the first stage of LIFT.

Good luck with your procedure this week.
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