Surgery – The Different Procedures
There are a number of different procedures to combat fistulas. Depending on your particular case and how severe it is, your surgeon, and even the country you live in, will determine which procedure may be recommended to you.
Definitive treatment of a fistula aims to stop it recurring. Treatment depends on where the fistula lies, and which parts of the anal sphincter it crosses.
There are usually several stages to treating a fistula. You may start off with a seton, and then have another procedure such as Advancement Flap surgery.
What follows are brief descriptions of the different surgery procedures associated with fistulas. If you surgeon is recommending any of these procedures to you, make sure you are prepared, research and ask lots of questions!
Doing nothing – A drainage seton can be left in place long-term to prevent problems. This is the safest option although it does not definitively cure the fistula.
Fistulectomy – Excision (removal) of the fistula track, allowing it to heal by granulation, so the tissue fills the space as it grows.
Cutting seton – If the fistula is in a high position and it passes through a significant portion of the sphincter muscle, a cutting seton may be used. This involves inserting a thin tube through the fistula tract and tying the ends together outside of the body. The seton is tightened over time, gradually cutting through the sphincter muscle and healing as it goes. Once the fistula tract is in a low enough position it may be laid open to speed up the process, or the seton can remain in place until the fistula is completely cured and the seton eventually falls out.
Draining Seton – A length of suture material looped through the fistula which keeps it open and allows pus to drain out. In this situation, the seton is referred to as a draining seton. A stitch is placed close to the ano-rectal ring – which encourages healing and makes further surgery easy.
Fibrin glue injection – This is a method explored in recent years, with variable success. It involves injecting the fistula with a biodegradable glue which should, in theory, close the fistula from the inside out, and let it heal naturally. This method is perhaps best tried before all others since, if successful, it avoids the risk of incontinence, and creates minimal stress for the patient.
Fistula plug – This surgery involves plugging the fistula with a device made from small intestinal submucosa. The fistula plug is positioned from the inside of the anus with suture. According to some sources, the success rate with this method is as high as 80%. This treatment option does not carry any risk of bowel incontinence.
Advancement flap surgery – This is a procedure in which the internal opening of the fistula is identified and a flap of mucosal tissue is cut around the opening. The flap is lifted to expose the fistula, which is then cleaned and the internal opening is sewn shut. After cutting the end of the flap on which the internal opening was, the flap is pulled down over the sewn internal opening and sutured in place. The external opening is cleaned and sutured. Success rates are variable and high recurrence rates are directly related to previous attempts to correct the fistula.
LIFT Technique – This is a novel modified approach through the intersphincteric plane for the treatment of fistula-in-ano, known as LIFT (ligation of inter sphincteric fistula tract) procedure. LIFT procedure is based on secure closure of the internal opening and removal of infected cryptoglandular tissue through the intersphincteric approach. Essential steps of the procedure include, incision at the intersphincteric groove, identification of the intersphincteric tract, ligation of intersphincteric tract close to the internal opening and removal of intersphincteric tract, scraping out all granulation tissue in the rest of the fistulous tract, and suturing of the defect at the external sphincter muscle.
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What are the different pain levels for each procedure ? I guess the ones that are cut open and need packing. I I had not read this or researched I would have no idea what option availablr to me. I’m having the dye interted and then they’ll decide whilst i’m under what to do. can i ask to be woken up and given the options to think about?
Holeybum - December 20, 2012 at 8:58 pm |
I had the LIFT surgery on monday an have not experienced a lot of pain. I got morphine following the surgery, but the next days paracetamol and ibuprofen was enough. I am on day 4 after surgery and take paracetamol once or twice per day. The area is very tender but I am not having any pains as such.
DarkRed - March 16, 2013 at 1:19 am |
Hi,
how are you recovering from the LIFT procedure? Do you still have any pain, has the fistula tract completely been eliminated?
barry ram - October 5, 2013 at 4:42 am |
hello,
I have had Crohn’s Disease for 35 yrs.
Had stoma for 4 yrs. now and surgery to remove colon, rectum, anus 2 yrs. ago. Throughout last 10 yrs. have suffered with fistualizing crohn’s, perianal abcess. With the complete removal of lower bowel I thought that fistual problem would be gone as diseased bowel gone….this week was told by specialist that I have peri-anal crohn’s disease and need a surgery called volvectomy. Any help would be supportive, thanxs.
Karen Cox - May 9, 2013 at 6:25 am |
My 31 yr old son is facing the same. First jpouch, then jpouch removal with ostomy placement, then anus/rectum removal due to multiple infections and surgeries. Had “ken butt” surgery February 2013 which wound has not healed, huge hole where his anal hole was; also recurring hospital visits for weeks at a time for fistulas popping up 4 places in butt now lower back. He had no active crohns. Doctors/surgeons dumb founded. What do I do?
Mom S
MomS - July 13, 2013 at 4:20 am |
I had a Lift procedure done almost 2 wks ago & I am still having mucus drainage at the opening outside the rectum ring. I wonder if this normal. I see my doctor in 3 days but the office staff says that this is normal but I beg to differ.
Desiree - May 22, 2013 at 5:14 am |
I had the LIFT procedure only a week ago and can echo that, given a post-op localized anesthetic injection that apparently lasted a couple days, and medications ( an anti inflammatory and an antibiotic) and a bit of ice pack after the first couple days there was not much pain at all. Discomfort, sure. I am wondering if it is normal to feel sapped of energy and strength for a long time.
Holly - July 4, 2013 at 10:24 am |
Hi, it’s now been 2.5 weeks – still mucusing plenty. Saw the doctor and he said there had been a bit of skin tearing, and to stay barely active – no heavy lifting or walking for exercise or climbing ladders. I stay in bed a lot waiting to heal – not working now as my work is very physical. Still getting stings of pain from the wounded area – hope it’s getting better’ inside and out
Holly - July 14, 2013 at 5:03 am |
Hi, it has now been over 3 months. The surgeon has okayed me for regular activity and last time I saw him, about a month ago, I was still having bleeding, mucus and pain issues. He examined me externally and said it looked ok and we’d play it by ear. I still bleed from my fistula opening and have some mucus from my anus sometimes so I still wear gauze. Not infrequently it flares up and becomes swollen, hot, and painful back there. Starting to wonder if it will ever really heal! I am going to log my symptoms for a few weeks and go back to the surgeon. It is tolerable to live with but not comfortable.
Hallie - October 12, 2013 at 8:18 am
Hi holly! I’m so sorry you’re unwell. After hell and back for two years of perianal abcess open wounds, fistulas and rips… The most agony I’ve felt and heard that others have felt above giving birth! … Id like to tell you that it was diagnosed as open for the rest of My life… But through changing my diet it healed against all odds. Cut out meat and dairy. Drink a heck lead of organic herbal tea.. Make smoothies… And do one thing a day that makes you smile. For me it’s my dog. Be it a you know what for the men, be it simply baking cookies! …. Point is, is I got better…. Hope for all of us friends. Xxx
kelliefisher51 - December 1, 2013 at 10:26 pm
Hi, 6 months post-LIFT-surgery here. I haven’t seen the surgeon since the last time I wrote. I am getting active again – going back to the gym and all that. Possibly the mucus leakage has stopped. I usually don’t wear gauze except sometimes at the gym. The swelling is not so common anymore especially depending on how long and hard I sit on it. I could be living a normal life now except I’m taking the option of not returning to work at this time. Healing-wise, the outside of the fistula seems to be healing over even though the inside is not healed – it is still a closed tunnel. So when the outer opening heals over, the tunnel fills with blood and this eventually pops. This has been going on a while. I suppose I COULD live like that forever… I’m going to call my surgeon and see if he wants to take any action or continue to wait and see. Just updating to see if any other LIFTers have had similar experience, or to let them know what my healing has been like.
Holly - December 28, 2013 at 2:53 pm
Hello. Just an update – I’m 15 months post LIFT now. A few months ago I went back to the surgeon because I was still leaking and still having flare-ups. He suggested that there must be a new fistula opening deeper inside if I’m still leaking and suggested a new exploratory surgery. The thought of paying for another surgery and going through all that healing all over again seemed excessive, and I can’t help wondering if he’s wrong about the new inside opening. Anyway, I really don’t like my surgeon and I feel like I can’t get enough answers from him. Anyway, since then it continues to sort of fade away. I never wear gauze anymore, though occasionally (active days maybe?) I resort to self-wedgieing or tissue but overall I remain so largely unaware of it I allowed myself to think it might still be healing. Only last night, though, I had to pop it again as it has healed over and was filling with blood. It still hurts like demons inside the fistula, but I only feel it when I apply direct pressure – usually I don’t feel it at all. 15 months after my LIFT and 23 months after the whole thing began I’m still wondering if I’ll ever heal all the way.
Hallie - October 5, 2014 at 5:36 am
Its very informative. But add information about Kshar sutra treatment . This is ancient Ayurvedic herbal treatment. In India people are preferring this technique instead of modern sugery.
DR. PRASAD BAPAT - July 10, 2013 at 5:50 pm |
Dear DR Prasad,
I agree but cannot find info about treatment in Sydney Australia. Can you lead to somebody that can do this as my GP is not aware of it. Also if you can please issue some reference material on this treatment also.
JMAN - August 31, 2013 at 3:08 pm |
See the animated video on YouTube to know how the Kshar sutra treatment works in anal fistula
Dr. Prasad Bapat - June 24, 2018 at 10:05 pm
I have the option of having my fistula ‘layed open’. I’ve already had 4 bits if surgery (including lift procedure which unfortunately didn’t work) and this is a new tract that only goes through a small amount of muscle. I don ‘t know what to do as would rather wear a seton long term than be incontinent….previous surgery has not been painful at all but the lay open option sounds scary…. Please help if you can…!
Me - August 5, 2013 at 8:39 pm |
I have been fecal incontinent ever since J-pouch surgery in 2008. It’s been really bad (lost my job, can’t really leave home) after getting Lyme disease in 2010. I also have a fistula that most likely formed because of the difficulty in keeping the perianal area clean. (I leak every 30 sec to every minute or so). All my CR has done has put in a draining seton and has prescribed antibiotics when things start flaring up again. It’s been nine months with this seton and I HATE it.
However, as much as my fistula hurts and the seton is difficult to deal with I have to say that the incontinence is way worse. I am never clean, my skin down there is raw, I develop fungal infections from always being wet, it itches like mad, and all that irritated skin runs the risk of getting an infection from the feces touching it which would lead to more abcesses and fistulae.
Now, keep in mind that since my colon has been removed that my stool is liquid. If you get the lay-open and become incontinent your stool would presumably be more solid and less frequent and perhaps easier to clean up and all.
Think of all the consequences and consider all the procedures available. Ask lots of questions before you commit.
-B
Betsy - November 30, 2013 at 9:04 am |
Just wanted to comment that this sounds very awkward and uncomfortable and I am sorry for it. I can only hope, in my relative ignorance of your circumstances, that things get better for you!
Hallie - January 21, 2014 at 6:30 pm
Ok , Had LIFT procedure carried out in september. WAs very sore and uncomfortable for about 3 weeks. Most of this was due to the wound which was left open. Went back to work after 4 weeks and all seemed good. In fact , I hadn’t felt so well since all this started.
Reviewed by the surgical team 6 weeks after surgery and they were hopeful it was going to heal ….. well , it was doing what it was supposed t be doing anyway!. Still felt great , right up til end of november when I got an infection which was cleared up with antibiotics.
Not felt so great since , still have a small amount of occasional discharge and if I’m lucky a small bleed as well.
Back to surgeons on Monday for a review to find out if it’s worked or not. Not sure either way how this is going to go. Whilst it’s nowhere near as bad as it was , it’s also not as good as it was before the last infection.
I suppose this could go either way , trying to be hopeful but mindful not to get my hopes up too much.
Will let you know the verdict on monday…..got everything crossed x
Sarah Byrne - January 18, 2014 at 6:58 pm |
Update…… Alas , LIFT hasn’t fully worked. Seems the internal opening has closed but the tract and the external hole are still open. Booked in for Advancement Flap in April. I would be grateful if anyone has had this procedure carried out successfully could give me any tips on how to increase the chances of it working could let me know …..Ill try anything within reason!
x
Sarah Byrne - January 21, 2014 at 2:26 am |
Sounds kinda like what happened to me, though I have been sorta abandoned to the healing process by my surgeon. It’s been 7 months since my surgery and still healing. Like you, I think the inside may have sealed but the tract and outer hole remained, but I think they are slowly healing. The outer hole has healed over a few times, and then burst when the tract filled too much with blood and fluid. To be honest, I think it might actually be getting better. Then again, I have thought that before… I figure as long as the internal abcess and infection that started the whole thing heals, I could conceivably live with an unhealed half-sealed fistula. I even have hopes of riding my bike again some day not too far off. Best of luck to you
Hallie - January 21, 2014 at 6:28 pm
Thanks for that Hallie , you’d think the internal hole would be more difficult to heal than the other . I’m in full agreement with you , as long as it drains and the dreaded abcess is kept at bay , that’s what really matters.
I have already pretty much decided that if this surgery doesn’t work (will be my 5th in 22 months!) they can leave my bum alone. I may let them put a draining seton back in , but no more slicing and tying for me after this one .
I’ll keep you posted
S x
Sarah Byrne - January 23, 2014 at 10:17 am
Hi guys , Went in for my advancement flap surgery last week and got lucky. Where the LIFT procedure had partially worked my surgeon has now been able to lay open the rest of the fistula tract . He did warn me that there was a 1 in 3 chance of slight wind and faecal incontinence afterwards but he was very optimistic he could get rid of the pesky fistula once and for all .
God , does it hurt!!!! mind you I’m thanking my lucky stars as I’m told the advancement flap is much worse pain wise.
Seems to be healing ok at the moment , loads of yukky discharge , hurts to sit on , hurts to walk about but I’m working on the no pain no gain theory .
Whilst I’m feeling rather rough because I now have a large open wound up my bum , it is a different sort of rough feeling than the constant “I’m trying to fight off infections” that these fistulas leave you with fairly permanently , so I am hopeful .
Keeping everything crossed (ok I can’t cross my legs of yet!) . Follow up middle of June when hopefully I shall finally be fistula free
S x
Sarah Byrne - April 26, 2014 at 5:40 am
I had my surgury about 2 weeks ago the surgeon left catting setons. My question is if the feces should pas through the setons. I do not know if this is normal. When I have bowel movement, it is very painful and the pain continues like that for 3 to 4 hours. I change the gauze often but, I noted brown material like feces. How long am I going to have these symptoms? The catting setons is an effective alternative. Pleace give me some info.
rafael - January 19, 2014 at 4:57 pm |
Hi Rafel , I didn’t have a cutting seton but I did have a draining one. Without wanting to sound too graphic occasionally a poo would get caught up in the seton and i’d have to untangle it. This could be what is happening to you.
I would suppose it is also possible that a bit of poo could enter the fistula tract from the internal opening , and therefore get caught up in the cutting seton and come out through the external hole of the fistula . I would get this checked with your dr as if this is happening a lot it will be a prime site for further infections which can lead to nasty abcess .
Hope you’re feeling brighter soon. I had my seton in for 6 months and after a couple of months I was feeling quite a bit better , not great , but still better than I was before the seton.
Hope that helps
Sarah x
Sarah Byrne - January 22, 2014 at 12:13 am |
Hi ive had cutting seton procedure. My first op was in November , then 23rd December and back to Doctor next week to book for next Op end of next week. It is a awful thing to go through, but ive tried to keep my life as normal as can be. Still going out in the evenings and socializing just be positive. Dont sit and be depressed, their are people who have it far worse. My top tip is keep clean do all all your salt baths and keep your head up. im not trying to play it down it is horrible but we can do it. Good Luck to all my fellow fistula sufferers. Thank you for the wonderful online support, whenever i panic or feel in doubt your just a click away.
Thanks Major Bum Sore
Despina Wessels - February 1, 2014 at 2:34 am |
I had the LIFT procedure done at St. Michael’s in Toronto 3 weeks ago. There was a lot of pain for the first 5 days post op. After that I felt better and better. Still have a small amount of drainage but not a lot. Still doing sitz baths twice a day. My surgeon said it looked great 1.5 weeks post op. Honestly haven’t felt this well in 3 years since my diagnosis. I urge anyone who has been diagnosed with an anal fistula to get it fixed immediately and make sure you go to a colorectal surgeon who has experience in all the different procedures. I wasted a lot of time with antibiotics and dietary restrictions to no avail and seeing general surgeons who didn’t specialize in colorectal procedures.
J - February 3, 2014 at 3:44 pm |
Update. I’m on week 9 of my recovery from my LIFT surgery. Feeling great. Had two scares when the external opening became very swollen but the surgeon said it was because the cavity created by the abscess (fistula) was scarring over and healing inside. That was a month ago and it has subsided. Feeling good and happy that this ordeal seems to be behind me. Please don’t delay getting your fistula fixed. You will waste your life away with homeopathic remedies and non surgical options. All told, I missed 4 weeks of work with the seton and the surgery. I probably missed that same amount over the years in sick days and feeling lousy because of the fistula. Plus I put off vacations, relationships and general quality of life because of this affliction. My only regret is not having dealt with it sooner.
J - March 20, 2014 at 12:39 pm |
Hi J,
I am on week 4 post LIFT procedure. This is my second LIFT surgery as the first one was unsuccessful. Can you please let me know how you felt 9 weeks post op in terms of symptoms (i.e. did you still experience any draining or mucus or blood? Can you still feel scar tissue where the external opening is)?
Thanks!
CDR - May 9, 2014 at 5:11 am
Hi CDR,
Oh no! Second LIFT…that’s no fun. I’ve heard that the majority of second LIFT procedures work well. Recovery was rough for me for the first 4 weeks but after that it healed really fast. I had no symptoms at 9 weeks but could still feel the scar tissue. I’m now 4 months post op and am feeling amazing. The scar tissue in the tract seems to have softened. There was no drainage from week 5 onwards. I did nothing except walk for three months but have been back at the gym, playing tennis, and riding my bike.
My surgeon had done 20 LIFTs prior to mine and had a 90% success rate at the time of my surgery.
Hope this helps. I’ll check back to see if you have any more questions.
J.
J - May 16, 2014 at 6:20 am
Hi C,
If you’re feeling nervous about the fistula returning, I suggest getting a properly trained colorectal surgeon to take a look at it. I don’t think I can reference names on here but there is a female colorectal surgeon who I saw at St. Michael’s. She is matter of fact/straight to the point. You can probably figure out who it is by googling St. Mike’s colorectal surgery department or ask your family doctor to look into it for you. It took me 3 months to get in to see her but my surgeries were both booked just two weeks in advance so once you’re in, you won’t have to wait if surgery is the option. I would go for coffee with you but am in Europe until the fall.
What I’ve learned is that every fistula is unique and while commiserating is helpful, it is best to find a proper surgeon with a good track record who can take action and fix it!
I am now on month 5 and so grateful for the new lease on life that I have.
Don’t waste anymore time feeling uncomfortable.
Best,
J
J - June 17, 2014 at 12:07 pm
Hi J I’m in Toronto too and looking for a good surgeon.. Could you tell me who yours was?
Thank you!!
Ismenia - September 13, 2016 at 7:57 am
I had the L.I.F.T procedure done by a female colorectal surgeon at St. Michael’s Hospital in Toronto exactly 13 days ago. I have a feeling it might be the same surgeon who treated you. I had my fistula for exactly 2 years, 3 months and 1 day before I finally had the procedure. Prior to having the fistula I had a large internal sinus caused from a reoccurring anal abscess that I acquired from an infected anal gland resulting from an internal lateral sphincterotomy I had previously to correct a reoccurring anal fissure. The general surgeon who originally did the lateral internal sphincterotomy on me actually did not follow the correct procedure in carrying out the surgery and it could be the whole reason why I ended up with the infected anal gland. I was told by one of Canada’s top colorectal surgeons that she made the incision in the wrong spot so what I consented to on the forms I signed was not the actual surgery I received. The sinus only became a fistula when the abscess came back and I went into the ER because of how much pain I was in and the emergency room doctor didn’t listen to me when I told her if she cut me open from the outside on my but cheek it would be creating a fistula because I had always had my absences drained from the inside. She cut me open anyways, insisting it needed to be done thus creating the fistula. It was at this point that I realized I was going to need a specialist and was referred to St. Michael’s Hospital in Toronto. I had the large sinus inside my anal cavity with a reoccurring abscess that had been drained surgically multiple times for about 11 months before it was turned into a fistula. I had a draining seton put into my fistula tract about 13 months after the fistula was created and diagnosed. The seton remained in my fistula tract for 14 months before I finally had the L.I.F.T procedure done. If you do the math correctly that means I’ve been dealing with anal/rectal problems for about 3 years, 4 months and approximately 3 weeks now. I had two colonoscopies done while the seton was in and one sigmoidoscopy done when it was just a large sinus in my anal canal. I’ve had multiple abscesses drained, several observations under anesthetic, and countless minor procedures done to better observe my fistula. My surgeon at St. Michaels told me I wasn’t a good candidate for the fistulotomy as the tract of my fistula runs too much through my sphincter muscle and incontinence would be a concern. For me, personally the surgery was very painful. Words really cannot describe the unimaginable amount of pain I was in the first 3-5 days post-op. There was considerable swelling and bruising. The first time I looked at it which was the day after my surgery was actually quite shocking. I couldn’t believe it was actually my body. I’m not a big fan of taking pills and tried to accept the pain as much as possible. After two days I caved and took the prescribed pain killers that were given to me. It was just too unbearable, and I consider myself to have a very high tolerance for pain. Still, I took them sparingly as I really dislike taking pills of any kind but Tylenol and Advil just weren’t cutting it for me. It took me two days post-op before I had a bowel movement which was also quite painful with a lot of blood. The prescribed painkillers made me constipated which didn’t help at all. The pressure of the stool pushing against my sphincter muscles was unbearable. It took me about 5 days for the swelling and bruising to go down and about a week and a half before I no longer needed the prescribed pain killers. It’s now 13 days post-op for me and I don’t require any pain killers what so ever and the swelling and bruising is gone. My stitches have completely dissolved, they actually dissolved after about a week. I am now left with a large gaping hole right on my anus where the incision was made. It does drain, but to me it appears clean with no sign of infection. I know it’s meant to drain fluid but I’m worried about it being so open and how that works with it healing. I hope it doesn’t heal oddly and I’m left disfigured. I’m not sure if it’s normal for it to be so open. I realized yesterday that feces actually gets trapped in the incision opening after a bowel movement and I have to lay in my tub with a mirror and a squirt bottle and carefully angle the nozzle to spray out the feces that gets collected in it. Never in my life would I ever imagine myself having to do such a thing. After I realized that though I’ve been cleaning it out that way after every bowel movement. The external opening of the fistula still has a considerable amount of draining coming out of it and it seems to be closing up but the tissue is red. I don’t know it that’s normal. I take regular long baths twice a day. I try to avoid using a sits bath as I find them to be quite painful. It puts a lot of pressure on my sphincter and wound area and also cuts off the circulation in my legs. I just have a lot of regular baths instead. I still keep the external opening of my fistula covered with a 2″ x 2″ gauze double stacked under a peice of Hypafix. My external fistula opening is about two and a half inches up on my butt cheek from my anus so I need to actually have it covered with some sort of adhesive bandage because the gauze won’t stay there on it’s own. I’ve been using the hypafix since day one and I find it comfortable and clean. I have relatively sensitive skin and as long as I change my bandage on a regular basis and keep the moisture to a minimum there isn’t too much skin irritation. Like I mentioned it’s day 13 for me and I do see improvement. I still have about a month before I have a follow up visit with my surgeon. I guess I’ll find out more then. The positives are the swelling, bruising and pain are gone, both my wounds look clean with no sign of infection, the pain right now is very minimal and my bowel movements are no longer bloody, still painful, but not bloody. These are all positive things. I can’t wait to be able to put this all behind me and I just hope this procedure works.
Stephanie - July 22, 2014 at 5:57 pm |
Hello Stephanie,
Thank you for sharing your story. IM scheduled for the LIFT surgery in the fall. I have my seton since April 2014. I cant wait to get rid of it…It’s not easy to manage work, husband,kids, soccer and sizts bath! 🙂
Work is the worse..siting all day drives me crazy!
My CS is not sure he will be able to do the surgery because the fistula seems very high (50% of y muscles)
Was your’s high also?
I hope your surgery is a success, after so long dealing with this you derserve it 🙂
cathy
Cathy - July 25, 2014 at 4:08 am
I had my LIFT surgery on July 9th, 2014. It’s now October 1st, 2014. I’ve had two follow up visits with my Surgeon and she has confirmed to me that the procedure has failed, meaning that reoccurrence has happened and now, not only do I have the original fistula, but an additional fistula where the incision was made for the LIFT procedure which just so happens to be directly on my anus. Like, I mean, right on top of it. Not beside it, like my original fistula is, but right directly on the opening of my anus. It’s quite painful. More painful than my original fistula and is constantly draining fluid. I don’t have a date yet but my surgeon is going to be putting the seton back into my fistula and likely another seton into the new fistula. It will remain there for a minimum of eight weeks. After that, we will decide what the next step is going to be. It’s going to either consist of me having more surgery or I can decide to live with the fistulas permanently and have the seton put in indefinitely.
I’m extremely depressed about this and the idea of living with fistulas and setons permanently really stresses me out. My doctor told me I need to be prepared for the possibility that my fistulas may never heal as this happens frequently because they are such a difficult thing to heal. It’s up to me and what I consider a better quality of life. Do I want to keep getting cut open in a painful and awkward area over and over with procedures that have low success rates or do I want to put the seton in permanently and just get on with my life living with the fistulas. It’s a hard decision to make especially since I consider myself to still be relatively young as I am only 29 years old.
I asked her again about having the fistulotomy and she believes that’s not a good option for me as my fistula is very long and deep and a very large portion of my fistula goes through my sphincter muscle. She believes I will definitely have loss of control over my sphincter muscle if I have this surgery and advises me against it.
I cannot even begin to explain to you how depressed I am over all of this. I have been dealing with these problems for 3 years and 7 months now and it’s exhausting.
Is there anyone in this group who is living with permanent fistulas and have opted to just put a seton in and live with it? This might end up being what happens to me and its a difficult thing for me to accept.
Stephanie
Stephanie - October 1, 2014 at 7:41 pm
Stephanie, I just wanted to reply with sympathy after reading your story. I lived with one Seton for about six months while waiting for surgery and I have to say I seem to recall it got to be kind of normal to live with. I don’t know what to tell you, though.
Hallie - October 5, 2014 at 3:50 am
Hi, I had a fistulotomy February 25th. Pain wasn’t too bad although the pain pills helped. I eased back to work but am still having drainage and sitting issues. My fistula began a few years ago and after 6 years of dealing with abscesses, er visits etc, finally went to ColoRectal guy. Had a draining seton for 8 months and finally had the fistulotomy. Question-how long before the opening heals.? I know it’s different for everyone but sick of dealing with the wiping issues and the drainage….
Leslie - March 9, 2014 at 2:22 am |
Please help I’ve had 5 surgeries from the flap to the plug which I just had on 3-28-14 I am in extreme pain the area is swollen and hard I went thru a lot of bleeding and then the next day no blood but the area is very tender and hard.i think the plug didn’t work and I just want to know if this is normal,the doctor said it looked good and it was normal.I need to know if this is normal the swelling and pain under my testicals that this happens while the plug is accepted into the body .Please if any one can tell me anything let me know.
John pisano - April 4, 2014 at 10:52 pm |
Hi, I had an abcess back in Januray 2014, drained and left open. Went for a follow-up appointmnent.. bad news fistula.
Had surgery on April 10, 2014 and woke-up with a red rubber seton. This is used to drain pus.
Went to the general surgeon yesterday and found out that the fistula went trough both muscles… He suggested to keep the seton and wait for the drainage to stop.
I was on Flaggyl for 7 days (Last day today.. Thank God). Once the drainage stops???
First option: He wants to take it out, this can take a few months I guess… than take it out and wait to see if it will heal.???
Second option: wait for it the drain and do a fistulotomy cutting both mucles, fixing the fistula and sowing the muscles back??? This scares me
Anyone had the same procedure.
I am from Canada Québec.
Very stressed and sad
merci
Cathy
Cathy - April 18, 2014 at 1:42 am |
Cathy,
Make sure your surgeon is conservative and experienced. Cutting the large sphincter muscle (especially in women) can cause fecal incontinence. If your fistula only passes through the small sphincter muscle, the risk is much lower but may result in uncontrolled flatus.
If you’re able to travel to Toronto, I would recommend the LIFT procedure by Sandra de Montbrun at St. Mike’s. She has a very high success rate.
Recovery was hard for 4 weeks but it’s much less invasive than a fistulotomy.
Best of luck!
J.
J - May 16, 2014 at 6:26 am |
Hello J,
Thank you for the info. My GS refer me to colorectal surgeon in Montreal. I will be asking if the LIFT is an option for me.
I will not be going with the cutting of the muscles, i’m really to scared!
My post Op went well, the inflammation is all gone (6 weeks)
Cant wait to see the CS and hope he can heal me.
Hope you are doing well.
If my CS has no experience with the LIFT, I will call yours.
Cathy
Cathy - May 25, 2014 at 1:02 pm
I also see Dr. Sandra de Montbrun at St. Michaels Hospital in Toronto, Ontario. I find her to be very caring, knowledgeable and confident in her practice. Although, in my particular case I have a complex and difficult fistula that is not responding to treatment. This doesn’t mean that she doesn’t know what she is doing, fistulas have a mind of their own and everybody responds to treatment differently. They can’t always be cured, but I trust in her judgement and I really feel like she is doing everything she can to help me through this medical problem. I highly recommend her as someone who has expertise in treating fistulas.
Stephanie - October 3, 2014 at 5:59 pm
Cathy,
If it is going through both muscles you need to see a colorectal surgeon. You are at high risk of incontinence if a fistulotomy is performed. You need sphincter sparing surgery like LIFT or Flap or even plug. Get a referral from general surgeon to see a colorectal surgeon. Trust me!
J - June 17, 2014 at 12:14 pm |
hi am pradeep 15days before i am having fitsula surgery . now i didnt went to motion properly in daily any tips for this issues??
pradeep - May 20, 2014 at 1:12 am |
This is to Stephanie’s reply above – don’t worry about “disfigured” too much, I had a fistulomy/lectomy and I was shocked a chunk of my flesh was gone, but it grew back 95% in 4+ months now (I do read that it takes about 2 years for wound to be 98% back to near original flesh condition) at the beginning when I went to the local wound clinic, they kept saying I had a fistula because of stool coming out from where the fistulomy/lectomy was done but after 1+ month that wound/hole healed and no more stool came out. So I imagine it’s just normal healing process so you shouldn’t have to worry too much.
It’s funny how wound healing works, I had 2 wounds – 1 is from the fistulomy/lectomy and it healed 80% during the 1+ month then it sort of stopped leaving a small cliff-like (by this time no blood) and when I push on it it hurted (scar tissue) compare to my normal skin. Then end of 3rd month it started healing a bit again.
My 2nd wound is from a big abscess (orange-size per Mt. Sinai surg ) this one is still healing 4+ now, the drainage hole healed 95% by month 3+ and since the small 1 or 2mm diameter stayed the same (thank god actually, so it allows natural drainage) <– This 2nd wound was a reinfection 2 days after the 1st surgery …. it was also from a surgical miss because Rudd clinic didn't take it seriously with no pre-op analysis decided to take a chance under EUA… that landed a 2nd infection more complex type of abscess (ischio) … the doc there was never able to explain me what he did and i just saw him keep re-interpreting the notes he took while recording on his tape and in the end he confused himself…. so yes big hospital is safer than private outpatient clinic in my experience
Mine is also a sinus, no internal opening found yet from 2 exams, going MRI in sep. I read a study sinus has more recurrence than fistula because it's hard to pinpoint the root cause of infection
I decided to leave it for now (2-3 sitz baths a day seem to help) I have no pain, just drainage (yellow, pink) and just 1+ week ago the drainage suddenly reduced from a Toonie size to penny and the wound seems dryer than 1+ week ago
I'm still monitoring and learning as I go
but I have a feeling that i should trust my body a bit and give it a chance to work out the reconstructuring by itself — from what I learned,,, sometimes you go to surgeon/doctor they'll just straightaway suggest to operate on you as a means of resolution and remunerations (win/win for them) … (surgeons are humans too so I can sometimes see them panic hence why suggest surgery…) but in the mean time the body might be taking its time to heal slowly
So I agree w/ all peers here dealing w/ this for a while – yes sometimes great deal of patience is required
Alright, take care Stephanie – let's hang in there
C - July 23, 2014 at 3:16 am |
Hey stephanie, please hang in there, maybe living w/ fistula for a while is not entirely too bad and watch your diet so you don’t have re-abscess For me it’s been 6 months after my failed fistulotomy, now another doc wants to operate on me and after 3 surgeries i’m getting quite tired of keep getting cut and doc said it was elective surgery and told me to keep area clean as possible, i don’t have much pain everyday and just put gauze every day + a bit of oil of oregano in m anxs hoping to help close my internal fistula (it worked / healed sooooooooooooo fast my external wound jst in a week that I had to stop apply to my wound because i want to keep the external hole opened) …. sometimes i wonder if my gland hasn’t heal why they keep suggesting sugeries, wouldn’t it re-abscess once healed? From this perspective I thought it’s better to keep fistula oepned? With ea. sugery my condition got a bit worse (fistula getting longer), so not sure can only speak for what i’m’ gong thru, anyway too sleepy now, will write again soon to cheer u up, I work near Eaton Center so whenever you’re depressed or need to chat i can be your listener, take care
C - October 2, 2014 at 5:12 pm |
I keep thinking about it and how painful the surgeries are for me and I’m considering just putting the seton back in for a few years and deciding then if surgery is right for me. I’m only 29 years old and I would have never thought this is what my life would be like in my late twenties.
My Doctor brought up that she wants to do the advanced flap surgery next and from what I’ve read about it online is that it’s quite painful with a low success rate. I just don’t know if I can do it. I have to have an observation under anesthetic as well as a seton placed back in the fistula for a minimum of eight weeks before I can have another surgery, but I just don’t know if surgery is right for me right now.
The LIFT surgery I had back in July was difficult for me to get through. It was quite painful and took a long time before I started feeling better. I’m still in chronic pain every day and it’s actually ended up doing more damage to my body. That was the risk though and I was aware of that prior to surgery.
I’m in quite a lot of pain every day. Some days are worse than others. It hurts to sit and I shift my weight around to not put too much pressure on my wounds and it has done damage to my lower spine and tail bone. I can’t sit anymore, it’s too painful.
I have all my surgeries done at St, Michaels Hospital in Toronto which is right down from The Eaton Centre. I’m familiar with the area. I don’t live in Toronto though.
Thanks for your concern and support. This whole process has been very difficult.
Stephanie
Stephanie - October 3, 2014 at 5:45 pm |
Ok Stephanie, thanks for reply and I see you’re strong lady, keep strong! Ya i see your points and I’ll consider it too for my coming surgeries, I might go and stay in asia next Fall for a bit so i’m also hesitating whether to have surgery (seton) here or there (over there, hospital’s website shows the stats of how many surgeries they go thur a year or what type of disease, here i never know if the doc knows
yap, i know what you mean about deteriorating the whole area, after my 3rd surgery because i always had to sit on one side, i had dull pain in my muscle too but gradually got better, so i hope it’ll for you too. After my 1st drainage, i didn’t know at that time but i still had much abscess and infection in (i thought they were tiny 50 scar tissues) and was causing me so much pain everyday when sitting i thought was just part of recovering but i was wrong and didn’t understand it till my 3rd surgery after my failed 2nd surgery that rendered me near sepsis situation. So i don’t know if you have any infections left or your pain is just part of the recovery phase, just so you can make sure with doc.
Ya finding and staying with a doc you trust is so important too, every new doctor would test you again from the beginning.
And same here, i look totally fine from outside but i have a unhealed wound and sometimes during rush hour on TTC i wish someone can after me to sit (I’m 34) but of course they wouldn’t give seat to relatively young man…. lol
ok then Stephanie, once again just hang in there – stay strong and know you’re not alone and someone in TO is available if you ever need to chat or in doubts i can give you email then. I have another friend (ex-classmate) who had re-abscess, maybe fistula and apparently it cured on its own, so we never know.
Keep in touch – chat soon/later~
C
C - October 4, 2014 at 10:45 am
fyi Stephanie, just came across this article
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3296947/
“…..Additionally, even if the fistula is not healed successfully, the LIFT procedure may convert a difficult-to-treat transsphincteric fistula into an easier-to-manage intersphincteric fistula….”
C - October 4, 2014 at 2:42 pm |
I just had fistula and hemorrhoid surgery last Friday and I am still in a lot of discomfort and pain. I have been doing sitz baths, 3 colace a day, milk of mag, prune juice, high fiber diet. Doc also suggested using a heating pad. I was wondering when will the stitches dissolve? And when will stop feeling pain and discomfort
Laura - September 20, 2015 at 2:01 am |
Hi i have had a surgery for fistula and have external stitches why ?
Sajeda suleman - January 14, 2016 at 9:41 am |
I have had a fistula done 8 days ago and can feel swelling around the stitches and throbbing pain and stinging.. Can it get infected so soon again into an abcess ???
Sajeda Suleman - January 15, 2016 at 4:07 am |
Sajeda what kind of fistula surgery did you have?
Racheal Dunn - January 30, 2017 at 4:10 pm |
I have had a fistulotomy, cutting Seton, draining Seton, advanced rectal flap surgery and now an advanced rectal flap surgery with lift procedure. I am so tired of having this issue. Seems like nothing works for me. So ready to cry. I can’t work or enjoy my family.
Racheal Dunn - January 30, 2017 at 2:24 pm |
Hi just want to seek help my wife is suffering CKD stage 5 she isunder going dialysis unfortunately she has a open wood connecting in her right neck now this access can’t Dr says need to do on the left is there any. Option coz my don’t want
Jonathan Carl Perez almonte - February 5, 2017 at 6:51 am |
I had a complex anal fistula for more than 2 and half years. I visited a number of doctors. At a nation’s top medical institution in northeast of the United States, I have done 5 major operations including LIFT, FLAP, and fistulotomy, and numerous debridement surgeries in office. Even with the aid of ultrasound and nuclear magnetic resonance (MRI) detection, doctors had not been able to find the fistula internal opening and root it out. It was so painful. I visited this web site many times.
After a comprehensive review, I planned to change course, and did a research for other doctors/hospitals. In Beijing, China, there is a specialized hospital: Beijing Anorectal Hospital (Beijing Erlonglu Hospital).
Early this year, I went to Beijing for treatment. The doctor was able to locate the fistula internal opening with finger examination. Ultrasound diagnosis can clearly and accurately locate the fistula track and the internal opening. The doctor performed Video Assisted Fistulotomy on me with a high definition probe/camera imaging system. After 2 months of surgery, the wound healed, but it was still tender. Now nearly 5 months, the wound healed completely. My fistula has gone!
In this hospital, I quickly found that I was not alone. There are so many patients like me. Some patients had more complicated and multiple fistulas. I had a roommate had 4 fistulas; the doctor performed 3 operations in a month and had all 4 removed and healed. The doctors are so experienced. The Surgery Ward II (department) have 4-5 doctors, do 12 operations each day by average; about half of the operations are fistula or perianal abscess.
From my experience, the most important factor in fistula treatment is to find the internal opening. It relies on the experience of the doctor and the right tools. You need to have an experienced doctor to operate, and a good team for post-op care. In my case, I had multiple surgeries before, the Video Assisted Fistulotomy played an important role for the doctor to “see” the cavity and track.
If you need any information or help, please let me know.
Eric - June 13, 2017 at 1:21 pm |
Hi Eric,
I just read your post. Would you be able to contact me with more information on the hospital and procedure you underwent? I’m very interested.
stephaniekmckay - June 14, 2017 at 4:50 am |
How can I contact with you? my email: eric.usa.999@gmail.com
Eric - June 23, 2017 at 12:24 am
Hi, what information about the hospital do you want to know? The procedures I undertook is the fitstulotomy combined with cutting seton. The cutting seton is for removing the fitstula that pass through the sphincter muscle, in which slow cutting and growing happens at same time. My cutting seton fell off on day 9th after the surgery, which is typical: about 7-10 days. The doctor initially planned to use some new scaffold materials to fill in the fitstula track after fitstula removal and cleaning, which was designed to grow and heal much faster; but for my case, the cavity was too big due to previous multiple surgeries. They just laid open, and applied a piece of thin long strip/pad soaked with their special herbal medicine, which was changed twice a day during first two weeks. The medicine was very effective. My incision grew quickly and stayed healthy. The surgery was successful and I am fitstula free now. Hope this will help. If you need the doctor’s info please let me know.
Eric - June 23, 2017 at 5:38 am
Hi Folks anyone had the FiLac surgery?? or VAAFT?? What were your results? Thanks
Dimitri - July 5, 2017 at 2:53 am |
I had VAAFT in Beijing Anorectal Hospital. It is very effective. My fitstula was successfully removed.
Eric - July 5, 2017 at 2:03 pm |
Hello everyone,
After having surgery to get my abscess drained (i had one in my left buttcheek, aprox 3 cm away from my butthole) I have now been diagnosed with a fistula. After that i went to see a specialist and he did some medical exams on me (echo in the bum, his finger, some other unidentified objects in there and an MRI). It turns out that I have a high but ‘blind’ fistula and it goes through my sphincter musscle. Even with all these tests, they haven’t been able to locate the internal opening. I seem to only have an external opening, at the place where my abscess was. Next week i am getting a coloscopy (yay…) to see if I have any bowel diseases and some biopts will be taken during this. Until my doc knows more, he won’t tell me what kind of procedures I could get. Even though i understand his point of view (not having to walk me through all the possibilities when not knowing if I have IBD or not) but still I would kinda like to know what might happen after this. The ‘not knowing’ is driving me insane to be honest.Does anyone have had a similar blind/incomplete fistula? If yes, could you tell me what kind of surgery/therapy you got?
Many thanks in advance!
Susi - August 21, 2021 at 10:30 pm
Can you tell me if it’s ok to have a smear test with a long term seton in situ please.
Gill pettit - February 2, 2018 at 9:38 pm |
Hi folks!
I had a LIFT surgery about 6 1/2 weeks ago for two fistulas- one of which was an ofshoot of the main one. When I went in for my 4 week post-op, I told my surgeon that I would pass gas through my incision site sometimes which he said was normal. He told me that unless the wound is still draining after a month, I don’t have to come in. I’m about 10 days away from that month mark and still draining. Every once it awhile I will still pass gas through my incision site, but very infrequently- it still makes me super nervous though! When I look look inside the incision, I can see two small open holes- makes me feel like new fistulas have formed inside the incision.
I guess my question is has anyone who had the LIFT surgery experienced any of these things? Does this mean that the surgery could be failing? Is it too early to know? I wish I had a better understanding of how the surgery is meant to be healing and if this is at all normal- the whole thing is so lost on me.
I still have puss draining from my anus and my incision site, but my original fistulas seem to be healed. I was never put on any antibiotics after my surgery, but I’m wondering if I should ask my surgeon to put me on some to help clear up the puss? Any advice anyone has would be much appreciated- this has been such a nightmare process & I’m only 22 years old!! Without Crohns!
Allie - February 13, 2018 at 4:16 am |
What’s the youngest age for Seton Ring? My 3 month old son with Perianal abscess s/p I&D and cauderization with silver nitrate. I have pediatric surgeon that is watching and see what happens approach. Don’t want to do harm but not delay care.
Ana Perez-Lopez - February 21, 2019 at 10:26 am |
Hi everyone,
I had fistula LIFT surgery exactly 5 weeks ago. I still have a thick white-yellow discharge. Is this discharge normal after this surgery? or does that mean the operation failed? any experience?
Tatjana - December 24, 2019 at 9:06 pm |
Hello, first of all I want to say, unless we go through this, no can feel our pain. My name is Anna, in Nov.2018 I was diagnosed with perianal Abscess, then got high complex fistula, have not been able to work, the o
Pain is unbearable. I had draining Seton, then lift, no I just had 3rd surgery with another Seton, I am dying from the pain, doctor said nothing to me what to expect, I can’t move, walk or sit, I do sitz, with salt, take pain killers, now I also have a fissure, this has taken its toll, I am so fed up, and my family members don’t understand why I Amin so much pain, I had surgery on July 8, and I still can’t move, I don’t know what to do.
fistula2018 - July 21, 2020 at 2:02 pm |
I think the high failure rate here is because the doctor did not find or treated the internal opening probably. I am going to have surgery next month and I am really not confident about it too. Worrying me too much.
jalascoo - October 21, 2020 at 2:31 am |
Dear “Fistula Support Team”
Thanks for your work giving fistula patients a platform for research and exchange with other affected persons.
We are a medical-technology company providing solutions for fistula treatment and know exactly about peoples suffering and the shame they feel, having anal fistula .
Therefore, we kindly want to point out that there is a further treatment method of anal fistula, you currently don’t mention on your website. The treatment is called VAAFT (Video Assisted Anala Fistula Treatment) and is conducted under a minimal-invasive approach:
The VAAFT technique is suitable for the surgical treatment of complex anal fistulas and recurrences. You can divide the procedure into two phases. The purpose of the first – diagnostic – phase is to inspect the fistula pathway with a Fistuloscope and to locate the internal fistula opening. The goal of the second – therapeutic – phase is the complete destruction of the fistula epithelium. Both phases are performed under direct endoscopic control of the Fistuloscope and without any skin incisions.
If you would like to read more about the surgical procedure, you can check out this document:
Click to access 3327734.pdf
or just investigate our website http://www.karlstorz.com searching for VAAFT.
There is also evidence of less recurrence rates choosing VAAFT instead of other common procedures. I will give you a sample of links to topical studies to check out:
https://pubmed.ncbi.nlm.nih.gov/32014596/
https://pubmed.ncbi.nlm.nih.gov/32030874/
https://pubmed.ncbi.nlm.nih.gov/29052068/
We would kindly ask you to add the VAAFT procedure to your website so that patients obtain a broad information and knowledge base and can decide which procedure they want to undergo.
If you request any further information (to studies, to the procedure,…), please don’t hesitate contacting me!
Thank you very much.
Theresia - October 14, 2020 at 11:09 pm |
Is anybody still reading these entries? I have draining seton for more than 2 months and the doctor is going to do FLAP for me. I found most people here did LIFT.
Does anybody have FLAP done and how is the result? I heard only 75% successful rate.
jalascoo - October 21, 2020 at 2:28 am |
I was given the option of Flap/ LIFT or fistulotomy for my anal fistula which is currently being dealt with keeping a loose seton in. I have been able to live comfortably for the last 5 months and often forget that I even have it down there. After some thought, I have decided to keep the seton in. And looking to replace it with the AMI comfort drain which looks more discreet and comfortable.
Perhaps this surgery will become more successful in the future, along with new technology including laser surgery etc.
I am thinking that if I can tolerate living with the seton/comfort drain that I am better off than going through the ordeal of current surgery options and the possiblility of surgery failure and back to square one. I especially do not want to increase my chances of getting incontinence too.
Anyone have thoughts on this?
Andy - October 20, 2021 at 9:41 am |