Hi everyone!
It has been a long time since I've chatted with you all!! I am having a situation in which I think some of you may be able to help me. I think I have a fistula...small, painful lump which drains every day, very uncomfortable/painful, and has been here for about 2 months. It started back in oct. and at that point I think it was an abcess, which drained, and was about the size of an m&m...got bigger, then drained. I thought it was gone and now it is back and will not go away. It drains every day, and hurts. I am trying to wait until after Christmas to deal with it, but it is really getting more and more uncomfortable. Any experience with this would be greatly appreciated, any suggestions...and please let me know whay kind of surgeries you have had that were successful or not.
Thanks so much!

hi there,
i had what seems the same as you, the longer you wait the more the chance the fistula could be become far more trouble some.
read the link below, kim our admin set it up when i asked if he could help me start a sticky about abcesses and fistula`s,
i had my abcess lanced and drain in hosi while under. and the wound left open and packed everyday by a nurse at home for 8/10 weeks, then had a laid open fistula op, which again need packed, ive still got on going trouble all caused by this, so my opinion is get it seen to A.S.A.P
and anti biotics do not work for these kind od of abcessses or fistula`s, surgery is the only way forward, sorry to say, but there are many options of surgery. dont go to a general surgon, get a c.r.s(surgeon that deals in butts only)
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Excision Treatments are
what is referred to as "off-midline abcess treatment
What off-midline means is to "stay out of the ditch" of the natal cleft. Wounds directly in the midline of cleft are the hardest to heal and are under the greatest strain from body movement. Wounds heal better when out of the midline where the tension is less and they are more likely to be exposed to air. The lower midline of the buttocks becomes an air seal that traps debris and bacteria in the area, leading to slower healing and greater incidence of wound breakdown. It is our opinion that any of 3 prime choices for surgical treatment will work effectively as long as the surgeon "stays out of the ditch."
1) Excision with Open Healing:
(aka - secondary healing, healing from the bottom up, healing from the inside out...)
What it is - In this procedure the abscess and sinuses are completely removed. The resulting wound is left open to heal. This is the slowest form of healing (8 weeks) but has a lower rate of infection and recurrence (5-15%) compared to traditional closed wound healing. During healing the wound is normally cleaned out and re-packed with gauze at least twice daily. Some surgeons do not believe in packing - as long as the wound bed is flushed with water twice daily we support this technique as well.
Where it's done - Excision surgery for Pilonidals is usually done at an outpatient surgical center and takes an average of about 45 minutes; it is typically done under MAC Anesthesia, Spinal Block or General Anesthesia. You will spend 4 to 5 hours at the clinic and then go home afterwards.
Recovery time - Approx 8 weeks. The first week after the surgery will be the worst and you really will need to be home resting during this time. Most doctors will advise that you can return to work after the first week. You will be advised not to drive for the first few days after surgery (nor will you want to anyway.) Some insurers will actually pay to have a home health nurse come and do your packing changes twice daily. Otherwise, it is possible to do packing changes yourself (I did all my own), but easier if you have a spouse/family member/significant other to help.
What else you should know - An additional technique called "Marsupialization" is also sometimes used (the edges of the open wound are stitched all the way around like a button hole) to keep the wound from closing too quickly. This speeds up healing time by several weeks.
For a detailed account of a surgery with open healing.
2) Excision with Primary Closure
(aka - healing by first intention, sutures, stitches)
What it is - In this procedure, the abscess and sinuses are removed and the wound is closed with sutures/stitches. Again, please note that its strongly suggest the surgeon stay out of the midline. Closed incisions that run into the lower midline are the hardest to heal and the most likely to fail.
Where it's done - Excision surgery is usually done at an outpatient surgical center and takes an average of about 45 minutes; it is typically done under MAC Anesthesia, Spinal Block or General Anesthesia. You will spend 4 to 5 hours at the clinic and then go home afterwards.
Recovery time - Approx 4 weeks. The first week after the surgery will be the worst and you really will need to be home resting during this time. Most doctors will advise that you can return to work after the first week. You will be advised not to drive for the first few days after surgery.
What else you should know - Excision with primary closure is an option for people who cannot undergo an 8 week healing period. The drawback is that the infection rate is 20-25% for this procedure and if you do get an infection then you will have to go through open healing anyway.
More recent medical techniques are now using Primary Closure with closed-suction drainage and antiseptic flushing of the wound --this seems to greatly reduce the infection rate, be sure to ask your surgeon about this if you are considering Primary Closure.
It is very important for sutured incisions in this surgery to be off the midline. Make sure you discuss this with your doctor!
The danger with closed wound incisions (especially those close or on the midline) is that this area of the body moves in many directions during daily life and this movement places a great deal of strain on the sutures, especially those inside the wound.
Also note, surgical wound infections can have very serious consequences (as in, fatal) so if you see drainage, redness, odor or swelling get to your doctor ASAP.
3) Cleft Lift / Modified Karydakis
(aka Cleft Closure)
What it is - These are both very similar procedures developed in-line with discoveries by Karydakis about the origins of abcess/fistula`s. In the Cleft Lift, the actual shape of the cleft is changed to be more shallow and allow for better healing. The surgery was originally developed to deal with surgeries that had failed to heal or continued to recur and is now being done more and more as a first surgery.
With the both techniques, the surgeon removes an ellipse as he/she excises the abbcess/fistula. The resulting defect, a football shaped "cavity", lies parallel to the midline but to one side. The surgeon removes the medial edge of the buttock. To cover the "cavity" the surgeon undercuts the other side and pulls across the midline a flap of skin and thick fat. The cleft becomes shallow and the single suture line lies in open air to the left of the midline. By almost flattening the cleft, the gathering of loose hairs is less likely, and the there is no portal of entry left for hair entry (they always enter a midline hole, not one on the side), thus greatly reducing the risk of recurrence.
One of the key elements to both the Cleft Lift and the Modified Karydakis are that all incisions are made to the side of the midline, never right down the middle.
Where it's done - Hospital or Outpatient Surgical Center. Usually scheduled as a day surgery with the patient going home that evening. In some cases and overnight stay may be suggested.
Recovery time - Patients usually return to work after 2 weeks. Healing is usually complete within 8/12 weeks.
What else you should know - Finding a surgeon doing this technique is challenging, you must be prepared to fight for a great crs.
For a YouTube video of the surgery, see this video *WARNING* this is an actual surgery and is very graphic. http://www.youtube.com/watch?v=XucofeyyGb8
http://anal-fissure.org/considering-surgery-or-already-had-it-f1/fistula-surgery-t1856.htm?sid=cfb948a7e99d55ac15ab616be9111b4b

Mother - I hope you are taking care of that fistula - it is not something to let "waiting" Longer you wait , more it can become complicated to fix it
Hope all is under control by now

well, I have seen 2 CRS and one says no problem, will do a fistulotomy using propofol and the pain isnt that bad after, gives his patients toradol and maybe percocet.(anyone ever taken toradol??) The other doc said he isnt sure if it is a fistula or a cyst and wanted to take a metal probe to probe it...not a chance buddy! I am in too much pain to even think about that...his concern is the location of this thing. It is what they call anterior which he said operating on this area in a woman has a high rate of leaving the patient incontinent with a fistulotomy. He said there are other treatments that he doesnt do such as a rectal advancement flap surgery...anyone have any info on any of this???? I am so confused and of course now I feel like it is abscessing again...I am in so much pain and of course it is SATURDAY.

Did you have initially a fissure that progressed to an abscess ??? :roll: Ever had a LIS ???
In any case, I really hope they will know how to approach your situation in the best possible way
Anal flap is not common procedure but is very "elegant" solution" and asks for a surgeon with extensive experience and dexterity. Since your suggested that procedure - I assume he must have been doing it often, but check, just in case.
You can find many articles on the net about anal flap, and some were posted here couple of times- try to use search option.
I know of at least 2 members so far that had it - one of them Kerrbear (sp.?) and she had great result.
Wishing you the best of luck