I had a seton placed almost 2 weeks ago and my CRS said I would need another surgery in December, what operation is normally performed?

OK OK a draining Seton??

Hi, I'm in the same boat and in two days am going in for the second surgery. It depends on how complicated your fistula is. I unfortunately have both a superficial AND a deep fistula so I will have two separate procedures on either side of the rectum where the tracks run. If superficial a fistulotomy will likely be preformed sometimes called "laying out the fistula". Basically it's just cutting out the entire tract and leaving it open. It creates a crater so to speak in the tissue and is allowed to stay open and heal. It does leave an ugly scar (according to my CRS but is better than having a fistula!) If the fistula is deep there are a few methods but my CRS said typically the most successful is called an "Advance Flap Replacement". It involves cutting out the fistula tract from the external opening cleaning it out, then doing the same on the inside opening. Then they cut a flap from the posterior rectum and pull the flap forward covering the hole and stitch it in place. The stitches dissolve and the external opening is left open to allow further drainage and the idea is that it will then heal from the inside out. My CRS said I can expect it to drain for about two months post op. Hopefully, after that it doesn't come back but I will follow with him for one year before he will give the all clear. If it does come back, which there is a 20% chance of that happening, the process begins again and the seton drain would be placed again. I've had the seton drains (3 of them-yeah lucky me) in since 8/20/13 and though I'm not looking forward to the pain of surgery I am looking forward to NOT having these stupid drains anymore.

I hope this is useful for you. Of course not everyone is the same and your CRS may have a different plan for you but from everything I've read and discussed with others this seems to be the general route. Good luck! OH you can also see a video on youtube of both of these procedures though be warned it has increased my anxiety about the surgery exponentially. I just couldn't resist knowing though : )

Hey Carrie, how did it go?

Hi! It went okay...I have a few tracks like I said in my original post and we had expected both an endorectal advancement flap as well as a fistulotomy. When he got in there however the side he planned to do the fistulotomy was too deep to perform that procedure. My CRS decided it was too much of a risk cutting the sphincter which often leads to incontinence. So he ended up placing cutting setons in that tract. In 30 days he will start tightening that seton with weekly tightening to follow and eventually it will cut itself out of the body and the fistula will heal behind it. Pain wise it's pretty intense. We had difficulty the first day controlling the pain but finally found a pain pill schedule that worked and today I'm bumping up the time between pills so that's a big step in the right direction. The dreaded after surgery first bowel movements have been surprisingly ok though at first I was so swollen I couldn't get a wipe or wash rag in between my cheeks to clean up. Swelling has gone down significantly though and now I'm eating solid food and taking stool softners to keep it as painless as possible. All in all I'm pleased so far with progress and prognosis and will just be a couch potato for another week and then hopefully get back to life. I don't know about these cutting setons and the pain I should expect with the process but will update on my progress with that. Off to heal!

Wow! What pain meds do they have you on? How have you been lately?