FiLac Time...

This sounds very promising. Surprised I haven't heard of it. Hope it works for you. Let us know how things go.

I had the FiLac surgery yesterday.
My recovery in terms of pain is fine, I feel almost 100%.
However, I have draining (significant) and I feel like the surgery has already failed!!!
I just called my surgeon (he is used to me crying over his shoulder) and I will meet him on Monday for follow up...
To describe my feelings I am quoting a Johnny Cash song:
"Six foot six he stood on the ground,
He weighed two hundred and thirty-five pounds,
But I saw that giant of a man brought down to his knees by love."
Just replace love with Fistula and you got it!

Thanks nofistulas, I will.

Thanks Memmem. I am at work today (1st day post op) wearing my wive's sanitary staff and supplies along to control drainage (ha-ha, I never even imagined this could happen, but you have to be humble in life).
I agree with you. I have read indeed that the 2nd filac surgery improves the chances (1st has a 60%-70% success rate and the second around 80-90%) however if you read the specific paper (author is a german CRS expert in Filac, named Wilhelm) it is quite tricky: The second surgery is not Filac in most cases, it is fistulotomy. Fistulotomy can be performed in the second stage because the fistula has become smaller (e.g from transphicteric it becomes intersphincteric).
So this parameter raises the success to 90% on the second try!

That is an interesting positive effect that the failed 1st FiLac surgery tends to have in about 50% of the cases (which is similar to the after effects of a failed LIFT surgery).

Let's wait and see: To be honest I have to see to believe. I am meeting my surgeon this evening after work to have a first follow up. I will keep you posted.

hmm. interesting. that's good information thanks. I've had more surgeries in the last two years than I can count and I've never been given antibiotics afterwards so I can't speak to its effect on drainage. but i'm curious if the drainage is clear, thick, color, smell? you can probably tell if the drainage is from stool leakage based on color and smell usually.

generally if the tract has not matured enough, then the seton needs to be in longer. usually 6 - 8 weeks is sort of the minimum. some have it in for 3 months before doing any fistula repair surgery.

I'm curious dmitri, how did they close up the internal hole in the anal canal? did they suture or staple? or did they not do anything and just use laser for that as well?

Fingers crossed it works for you, but if you were still draining pus down the seton, it sounds like there was still an active infection somewhere. That will want to keep draining, so there seems little chance the wound will heal up. I had a drainage seton installed nearly six years ago in a very high (according to my CRS) trans-sphincteric fistula, fortunately without any problems since. The CRS said there was no surgical solution without either a high chance of incontinence or a high chance of recurrence - I should just learn to live with it. In my case, the pus drainage took the best part of a year to stop. Now I eat plenty of fibre to keep BMs loose, which I'm lucky are regular first thing each day. I can then take the dog for his morning walk and the brown drainage down the seton will happen while I'm active, I can wash before I leave for work and feel clean for the day.

I was given antibiotics after having the seton installed and before, when first diagnosed with the abscess that caused the problem, but I don't think any of them had any effect, apart from upsetting my stomach.

From all I've read in the years since, the two issues with fixing a fistula would seem to be removing the granulation lining of the tract and closing the internal opening. VAAFT seems to get decent results as it addresses both, as the method recommends a suture to the opening, but would be tricky as my fistula was starting to horseshoe (the CRS description) and the VAAFT equipment is rigid. I've been pinning hopes on the FiLac method, but I'm not convinced by not closing the internal opening.

On the plus side for you, at least it sounds like you still have a full choice of options for the future if this operation hasn't worked and you're active again. Can't think of anything worse than ending up incontinent - wearing the wife's pads is humiliating, but better than that. Keep positive.

Drainage nowadays, some brown in the mornings after a BM, generally helped to drain down the seton by a fast walk with the dog - guess you could go for a jog and get the same effect. Always wear a gauze for that, then have a wash when I get home, before leaving for work. Drainage for the rest of the day is minimal and all brown, no pus - I do wear a gauze, but that's mainly for my own reassurance, so if I do drain at all I can change gauze in case it smells. If I'm honest, I don't really need the gauze after the morning drainage, but I don't like to think my co-workers might notice any strange aromas around me. I could just forget the gauze and give the area a rinse at lunchtime in the company showers. At night, I don't bother with the gauze - nothing ever drains out, partly because I suppose whatever got caught in the fistula during the morning BM has gone by then and partly because when I'm laid in bed gravity won't work on anything that did want to drain.

This is all very different from the first year or so, when what drained down the seton was a committed green and ran all day and night. Got through a lot of gauze in that time. I know I've been lucky with the drainage seton, given the horror stories you can read online about some people's experiences with them, but after the infection went and the drainage slowed to just a slight morning dribble, I wouldn't know I've got a fistula, apart from changing gauze now and then. It would be nice to be cured of it and I keep an eye on stories about new techniques etc, but I'm not going near any operating theatre unless both the technique and the surgeon can demonstrate a 80 or 90% plus success rate and no incontinence - I just don't think it's worth the risk.

My first year was horrendous and I feel for you (and everyone else) going through it. In thatyear I'd have given my right arm to be cured, but now it's all calmed down I'm much more relaxed. Maybe in a few years, when there's a larger body of evidence behind FiLac, and particularly some research into the causes of failure, so the technique can be refined and improved, I might go for it - it seems the best possible solution available for me at the moment. In the meantime I focus on family life and try to forget about it.

Hope you find all this waffle in some way reassuring that the future is not all lost for you. At the risk of you falling off to sleep reading this, I found when researching my family history I had a great grandfather who developed a fistula in 1885, whilst in the army. His medical notes read that it was treated by being 'stuffed with carbolic acid and lint', which must have stung a bit, but sounds similar to a drainage seton. Spent over three months in military hospital being treated. He went on to live for another 52 years, married twice, fathered ten children, respected member of local community etc. I wouldn't be here if a fistula had stopped him having a normal family life. I have an old photo of him hung on the wall at home as inspiration - if he could cope, so can I. Hang in there, my friend - don't let a fistula stop you.

Quaye, thanks, that's a great-great story! It is a real motivator indeed. I have 3 kids but would not mind more (with the same wife).
Your situation sounds good. One thing I would investigate if I were in your shoes would be whether the fistula has "migrated" lower during this time, thus making a fistulotomy or a cutting seton feasible. Have you checked that out?

nofistulas: how are you doing post LIFT? Are you still hopeful? Has the situation improved?

All the best to all.

Hello, looking for some help - No chrons (determined by colonoscopy)

Filac preformed September 22, 17 for a high more Han 50% muscle fistula. I have had it drained twice and Filac was my last procedure. The doctor was able to find the track all the way through and prefer but could not push the internal.

Filac was a piece of cake no issue at all. I have been draining ever since the surgery on and off. Mine is for yellow looking drainage. This Friday will be 6 weeks. My doctor told me it could take up to 3 months to know if it worked or not.

It’s not painful I would say more uncomfortable than anything. It does seem that this week has been better but still drainage. For those who have had FILAC can you share the timeline and experience.

yes dimitri, there's very little info on actual Filac patients - at least I couldn't find much. So your experiences will definitely help. i'm considering it myself so i'm very curious as to yours and karens feedback on the recovery.

It almost sounds like maybe stool is getting into the tract if the drainage is still brownish. Are you having any pain? Is it abscessing? I'm wondering if maybe it would have been better if your doc has sealed the internal opening. who knows.

as far as my failed LIFT, still recovering. honestly didn't think i'd be in this bad of shape even after a failure. I seem to be stabilizing though. I still have a long wait until we try again. i must have been a really bad person in my past life...

Hi to all here!
It's been a week since my last post and I am now on my 20th day post surgery. To sum it up: I would say I am doing better overall, however I don't think the fistula will heal...In any case I will meet my CRS next week to have a formal follow up. If it was up to me I would meet my CRS everyday for a short brief (ha-ha), even if I had to pay for the visit (ha-ha) but unfortunately he does not wish to become my therapist as well.
Drainage has somewhat decreased and is improving, but it has not stopped. I would say 50% lower than what it used to be prior to the surgery and more liquid as the wound is healing (it is yellowish, brownish, greenish etc., the whole stuff).
The secondary extension of the fistula seems to be going well VS prior to the surgery. So overall some improvement, more bearable. If I had to make a - wild and not scientific - guess, I would say that the secondary fistula extension (which was cut off) will close while the primary fistula (which was treated by FiLac) will remain open. But that is just a really wild guess.

The other thing I have noted is that I don't see an active pus source (meaning oozing pus) as I could on my previous (seton) surgery where I could see the pus coming out from both the seton hole and the secondary fistula (however my guaze has coloured exudate as I mentioned above).

Overall the surgery has made it more livable (so far). It's too early though to judge the whole thing as there is a wound and it will take time to heal and present the whole picture in a more concise manner.
In terms of sports I am 100%, doing everything that I want. There is some ache in the wound when I seat and move in / out of the car, as well as on the edges of the wound, but gradually decreasing. I will update post my CRS visit. All the best to all co-fistula sufferers and to the people I've come to admire, the Crohn sufferers.

Post Edited (Dimitri71) : 11/14/2017 2:37:23 AM (GMT-7)

Thanks no fistulas.
just a quick update.
I actually went today to see my CRS, he had a spot and as I was eager, I grabbed it.
He said that things look good, and that the secondary track is healing. He gives an 80% chance of success now.
Mind you, prior to the surgery he gave me an 80-90% probability for success. Right after the surgery he gave me a 50% (I describe above his rationale) and now when I asked him if it is still 50%-50% he said "no it is significantly more". I pushed him about the percentage and he said 80%. But he said it will take two months to heal....
Really, I wish I could believe him.
In any case, drainage has further subsided (to about 20% of the original amount) during the last two days and it is very light yellow now. He said it is not puss just serum and reconstructive liquids. I wish I could believe that as well.
I give myself a max 50%-50% with better chances for the external secondary fistula which is supeficial (which looks good now).
God bless and keep strong to all. What does not kill us makes as stronger... especially chronnies, who I admire like nobody else...you are in my heart...I think this disease is making me a lot better as person and more sensitive to the other's pain. God bless for that, that's a great gift in in life, even if its fairly late (I'm 46). I've been a prick and many times insensitive to what others go through and if a fistula is what made me realize this, then I embrace it! Sorry for rambling.