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Anyone have experience with the Anal Fistula Plug (AFP) treatment?

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Crohn's Disease
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Posted 1/14/2009 7:00 AM (GMT 0)
I'm considering this as a possible treatment.  Anyone have experience (good or bad) with the Anal Fistula Plug?
Posted 1/14/2009 12:01 PM (GMT 0)
Hi again,

I haven't tried this because I'm concerned about abscessing. I've had my fill of those, thank you very much. My colo-rectal surgeon said the plug works better in non-crohns, and only has a 50-60% success rate in crohn's. It is non-invasive and if it doesn't work, it just pops out and you can try again. But there is a risk of abscesses. Stuff could get trapped in the fistual tube as your body works to accept the plug.

I suggest you search for previous posts. I remember that a number of people tried the plug with mixed success.  How high is your fistula in the rectum?  If it is low (not above the sphincter muscle), then a fistulectomy might be an option.  The whole fistula track is cut open and heals.  It has good success.  Not for me because the fistula is too high, and cutting that much sphincter would leave me incontinent. 

The other option my surgeon told me about is the advancement flap procedure, where a flap of tissue is folded over the fistula hole to seal it.  Again, it is more successful in non-crohn's and only 60-70% in crohn's.  A high chance of abscess if it fails.  My doctor said he wouldn't do anything until the whole area is calm.  He said the setons keep it open and draining (so the abscess area attached to the fistula can heal), and to focus on getting the fistula to shrink.  Drugs like remicade and humira help here, if I weren't allergic to them.  Other drugs are in the pipeline too.  So now I am happy with the setons, and am just waiting to see if the fistulas will shrink.  Maybe later I will be in a gambling mood to try the advancement flap procedure.  For now, I am very happy to not have abscesses!

I'm hoping you have a colo-rectal surgeon who is very experienced with crohn's.  Very, very important because we don't heal or react the way normal people do.  These are hard decisions and you need the most experienced advice that you can get!

Take care.

Posted 1/15/2009 12:09 AM (GMT 0)
Hey FallColors thanks so much for the insightful feedback. I'd rather try the non-invasive procedures first like you recommend, then go for the heavy guns (Remicade, surgery, etc). The crazy thing is my CR surgeon took one look at it and said you have Crohns im not operating on you, you're going on Remicade. I left feeling like that he didnt give it much thought. My fistula isn't very big but it's annoying. I need to get my CR to take a look and see how far up it is. I'm trying some antibiotic ointment but about to give up on that. I posted another thread about that. Today is the third day. I took a hot sitz bath this morning and applied the ointment. The miracle is that it has shrunk up very small and for the first time in having it for a year and a half now, there is NO pain coming from the site--I can sit on it with no pain or discomfort and it has shrunk up from what it was. I know the odds are stacked against me, but I have noticed a  difference although it probably wont last.  I think i'm going to ask my GI to get me on a Flagyl regimen again before trying a seton as my CR surgeon has decided is the best option.
Posted 1/15/2009 1:59 AM (GMT 0)
Hello,

I think what your CR surgeon said demonstrates that he/she has experience with Crohn's. Your thoughts about keeping the rectum sterile is actually the basis for how they treat fistulas that get out of control -- they disconnect the colon from the rectum for a few months (temporary colostomy). There is no other way to keep the rectum sterile enough. The meds help stop the crohn's inflammation process, which caused the abscess fistula in the first place.

I am sorry if what I said gave you the impression I was recommending the plug. While it is non-invasive, I personnaly don't like the odds of success in Crohn's and will not risk abscessing.

This is all a personnal choice. I suggest you go on medline.com and read more. Here is an really excellent overview. Be sure to click on the links in the "Contents" box at the bottom of the webpage to get the full article.

http://emedicine.medscape.com/article/190234-overview

I truly hope you are able to heal. Please keep in touch.
Posted 1/15/2009 4:11 AM (GMT 0)
Thanks FallColors!!! I think i'm going to look into the plug route given I had it healed up pretty good from a few regimens of Flagyl. I'm thinking of asking my GI for another round as it has been several months since I tried that and worth the try again. Only thing , is it can irritate the fistula and make it swell up given it causes me to have D.  If I have any success i'll keep you all posted. The biggest issue which i'm sure many fistula sufferers can relate to is the constant discharge of pus mixed with blood. The thing swells and is a pain in the you know what.  It takes a toll on your self-esteem and has made me more self-conscious but some days it's not so bad where as others I just want to come home and veg out!!
Posted 1/15/2009 12:08 PM (GMT 0)
I recently had the plug surgery with flap this summer or a vaginal-rectal fistula that I have had for 10 years. I can proudly say that it was successful! I had the draining seton placed 4-5 weeks to help drain any fluids from the infection tract. I was aware of the low success rate for Crohn's patients but my Colorectal Surgeon had previously worked on 16 Crohn's patients undergoing the same type of surgery and they were all success stories so I went into this very optimistic. She did place the Surgisis plug but also used a flap closure towards the internal tract site. I wish you luck with whatever decision you choose! If you have any more questions please feel free to ask.
Posted 1/15/2009 12:12 PM (GMT 0)
I need to also tell you that sitz baths are your best friend at this point! You cannot sit in them enough. Take as many as you can for pain and for fast promotion of healing. wink
Posted 1/15/2009 1:02 PM (GMT 0)
That's wonderful LauryLu!! I am so happy it healed properly! So just to be clear, you had a seton for 4-5weeks prior to surgery. Then they removed the seton, inserted the plug, and created the flap. Is this right? The flap sounds like what my surgeon called the advancement flap procedure. He said it has about a 60-70% success rate in CD patients. Its so good to hear from someone with a success story!! How was your recovery post-surgery?
Posted 1/15/2009 7:36 PM (GMT 0)
Yes I originally went in just for a Fissure removal and I came out with a draining seton! I was so confused and scared because I had no idea what the surgeon did to me. She said that once she was in there she saw how infected my fistula tract was and said she needed to work on it to prevent any infections that could of been created with the work of the fissure. So the seton drained the tract for 4-5 weeks. During this time I took lots of sitz baths, tried to keep the area clean at all times with a peri bottle filled with warm water and wipes and always had guaze pact in the area to soak all the leakage up.

Post recovery from plug/flap surgery was fine...of course a lot of discomfort for the first few days but that is when the pain killers came into play. I was prescribed a Flagyl cream to be placed on the site each day to prevent infection and also an oral antibiotic. No heavy lifting, no standing or walking for too long at a time while healing and of course you have to watch what you eat bc having a movement can be painful, having been cut up in that area an all. Things cleared up pretty fast considering. My surgeon said that my tunnel was "superficial" and not so deep so she was very optimistic that it would heal quickly. The plug sometimes takes a bit to adhere to our skin, being that we have Crohn's. I want you to also research Arnica Montana to take before and after surgery. This is a homeopathic drug that speeds up healing process from surgery. I personally thinks this helps and there are even some surgeons who recommend this to patients - worth taking a look at. I hope my story gives you a little more hope!
Posted 1/15/2009 7:53 PM (GMT 0)
Thanks LauryLu! I'll look into the supplement. I have been looking for a good herb blend to promote healing. Hopefully, my tract is superficial like yours, i'm jealous :) I also make the SCD yoghurt that you have in your tag line. It seems to help. Cheers
Posted 1/15/2009 11:11 PM (GMT 0)
Thanks LauryLu for sharing! That sounds like what my surgeon said, except he said after the advancement flap surgery I would need to be in bed for 3 weeks. Not because it is that bad a surgery but just to give it the best shot at healing. He said the less movement the better.

My story is similar to yours -- woke up with a lovely white seton! My doctor said to think of it as special body piercing. Yeah, right. Once I understood what it was there for, I was OK with it. And they are doing their job (along with the drugs) -- infection and inflammation are gone. Later I got a blue one, and now they are both red. I liked the blue color better. Too bad they don't come in designer colors and patterns! Maybe I'll get brave and try the surgery... You have an encouraged me!
Posted 11/17/2009 1:19 PM (GMT 0)
Hi there i was wondering if anyone could tell me a little more about the Anal Fistula Plug? what they do and what is it made of i also have 2 seton drain in place in my left buttock through to right near my anus my surgeon put me on the waiting list last month the have one of them filled. Mine are due to Cancer surgery 4 1/2 years ago, i had an illiostomy bag for 2 years while i healed (very slow to start) then had it rejoined was it ok for 12months then up came 2 abccess which were drained and settled down only to come back times 2 a few months later i was on 2 very strong antibiotics till about two months ago and things seem to have settled down quite a bit hence he is going to try to fill one of them, so any information would be welcome... P.S i have not needed sitz baths due to the illiostomy which had to be redone to help with the infection.............. thanks I posted here because it was the oly place i could see that had what i was looking for i dont have Crohns... blush

Post Edited (NeeN) : 11/17/2009 6:22:12 AM (GMT-7)

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