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Fistulotomy failure just 6 weeks post-op?

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Posted 9/11/2017 4:29 AM (GMT 0)
So I do not have Chrone's disease but I didn't know where else to post this and I'm desperate for answers at this point.

I had a fistulotomy performed on July 31 after 3 years of perianal abscesses. I thought it was finally the end of the painful nightmare after trying a fibrin glue procedure to fill the fistula last year (didn't work obviously).

Draining persisted following the fistulotomy on July 31 but gradually decreased for about 6 weeks.

And then today, about 6 weeks post-op, I feel another abscess coming on in the same spot I had the fistulotomy.

I couldn't believe it. Is my fistulotomy already a failure? I've heard of people who experience draining for 6 months, but my stopped after just 6 weeks and already an abscess in the same spot, as if I never even did the fistulotomy.

I never thought I'd have to experience that pain again, and now I feel the abscess coming on and its petrifying and depressing. It's like a nightmare that just won't end (hence the username).

I have a previously scheduled post-op appointment coming up this Friday, and I'm going to try my best not to seem like I'm pissed off at the surgeon, who is supposedly one of the best in the area at this kind of thing.

He seemed so sure that surgery was a success, told me it was very superficial and left the recovery room without saying anything else.

So is it really possible that the fistulotomy is already a failure? What else would explain the return of an abscess so soon after the fistulotomy?

Answers from anyone with any knowledge would be greatly appreciated sad
Posted 9/11/2017 4:49 AM (GMT 0)
Hi there,

I'm in a slightly similar boat to you. After battling an abscess for a few months I had it drained. It didn't heal so I got a seton for three weeks. That fell out, so the surgeon performed an advancement flap, as my fistula is high It felt good for a few weeks and the draining decreased hugely but then, a few days ago, the nurse told me that the wound depth hadn't changed, and then draining started to increase. I also noticed what I think was a few specks of fecal matter in my drainage. Obviously that wouldn't be happening if the internal opening wasn't there, which would mean the flap failed.

Truth is, I don't think there's any easy answer to healing a fistula. Have you had an MRI? The surgeon may have opened up one track but there could be another feeding it from elsewhere. Also, the original fistula may just be 'active' so the fistulotomy didn't clear it up completely. Did you get it packed so it didn't heal over too quickly? I've read that most fistula return because the inside did not heal before the outside.
Posted 9/16/2017 10:15 PM (GMT 0)
dbrookenz,

I really appreciate your reply! Sorry for my late response, I wanted to wait until my post-op appointment yesterday.

Your situation indeed indeed similar to mine. I'm really sorry you're going through this too. Something as seemingly simple as an abscess that the body cannot heal on its own is so strange and foreign to me.

So the doctor seemed baffled. He can't fathom that the fistulotomy didn't work. He said "maybe it was just a small left-over pocket that drained." Clearly that's not the case, since it swells up then drains just as the cycle went before surgery.

I've never had an MRI, to answer your question. Nor did I have it packed. Maybe he figured it was simple and straight forward.

He probed around and then told me "I wouldn't even bring you back to an operating table because I wouldn't know what to operate on," implying he took care of the fistula tract and can't find any others.

He thinks the tract I'm feeling when I push behind the abscess is the original one that was operated on and is now "scarring."

I'm honestly sick of the narcissism and implication that he couldn't possibly have failed.

He told me to come back (again) in 4 weeks. I honestly don't think I want to shell out more money for 10-minute appointments just be told surgery was a success when it wasn't.

So what's your next step, dbrookenz?
Posted 9/17/2017 12:55 AM (GMT 0)
Thanks for your reply!

I would seek a second opinion. From my reading a fistulotomy is usually successful but not always and there may need to be a second or third operation. Fistula are not always simple things to cure. I thought my flap op would deal to it but no luck. I think you know your body best and if you feel like another abscess is forming then it probably is. We both know what an abscess feels like and it's not like scar tissue. I'm doing all my operations through the public health system in NZ so I don't have to pay. Unfortunately it means weeks between appointments and living in discomfort during that time. I hope things sort out at your end! Please ask any more questions if you have any.
Posted 9/17/2017 2:22 AM (GMT 0)
I agree, you definitely need a second opinion. Doctors who don't admit they can be wrong or they don't know need to be RUN from.
Posted 9/17/2017 3:02 AM (GMT 0)
I agree with scifigal. It puzzles me why you had a plug tried first? From what I've read for a simple fistula (low fistula) a fistulotomy is the gold standard and the 'go to' before anything else. Usually the plug, or flap, or LIFT etc comes after that has failed? In any case it proves that maybe a second opinion would be a good idea?

Don't get too disheartened. I know how easy it is as fistulas are often complex to treat. I'd never had any issues with that area aside from a sensitive tummy and suddenly I got a huge abscess at the start of this year and it's been a nightmare ever since. Drainage, then the general surgeon couldn't find a fistula track, then my specialist found one so put in a seton which hurt like hell and ended up falling out, then an advancement flap op which has failed, and I'm back in pain and discomfort. A fellow sufferer on here offered some wise words - the fistula always loses in the end. Keep that in mind. It's a marathon, not a sprint. Keep your spirits up!
Posted 9/17/2017 5:56 AM (GMT 0)
Was your surgeon a colon-rectal surgeon? If not I would get a second opinion from one. Was a seton an option? That keeps the fistula open so you're not going thru the abscess, pain, break open, repeat. It also allows the fistula to heal from the inside out. I had a seton placed last summer and it's still in and keeps my fistula from closing up an abscessing again. I have Crohn's so it isn't as likely to heal, but may be more successful for you. At the very least it keeps the pain at much more manageable levels.
Posted 9/19/2017 3:55 PM (GMT 0)
While sometimes a fistula can become complex, they are pretty simple from a mechanical standpoint. They are just a pocket of bacteria that is looking for someplace to go. I went through a fistulotomy a couple years ago and I still go into full panic mode at the slightest discomfort in that area.

It may be that your body just healed from the outside - in instead of from the inside - out. I would consider asking to be seen in two weeks, as opposed to four. Most doctors are understanding if you explain that you are having a difficult time and would appreciate a little extra attention. If that fails, you could always go to the emergency room if it abscesses again and demand an MRI. It is easy to get mad at the doctors but there is only so much they can do. Sometimes they need to wait for your condition to 'show itself' a little better before they can act, as frustrating as that is for us, the patients. All I can say is that this will pass so hang in there.
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