Fistula advancement flap surgery

Hi Zoe, nice to hear from you again!!
Thanks very much for the update, really appreciate it.
I hear from what you describe both good and bad news, so I understand that there is some incremental improvement, maybe not as much as you'd wish, but nevertheless some improvement. That's good!
I am in the same situation as you, currently entering my 4th week. I feel (certainly not cured) slightly better...Baby steps towards success!
I look forward to your news from you visit.
All the best!

Post Edited (Dimitri71) : 11/18/2017 12:41:20 PM (GMT-7)

Sorry to hear that, Zoe.
I need to go in for my final appointment in late January to confirm, but things are still good for me so far.
There were a couple of times where I thought stool was coming from the fistula wound, but it's not an everyday thing.
I've never done the LIFT, but I'm on a fb group called Abscess Fistula Support for Women, and I haven't heard a lot of positive things about it.
I forget, are you on meds? I'm on Entyvio only as of July and I think it added to my chances of success.

Hi Zoe, thanks for updating us first of all.
Although the result is negative there is a piece of good news (your fistula is smaller) which is great.
The LIFT is a great next step for you.
It is the preferred surgery for all mid to high fistulas in the USA. The Lift has no real danger in terms of continence (while the FLAP does).
It's a great choice especially due to the fact that even if it fails the fistula definately becomes easier to handle (e.g. from high it becomes low). This has been proven in various studies.
In terms of my Filac, I really doubt that it worked. 28 days post surgery and still draining. i saw my CRS 1 week ago and was optmistic, but he is always that way. I will see him in about a month since he claims the draining can indeed last that long.
I have to admit though that -at least for now- drainage has improved somewhat vs prior to surgery.
For the LIFT you should read the US CRS guidelines for the treatment of Fistulas.

My most recent surgery was a failed LIFT. Disappointing for sure, but the good thing is you can repeat a failed LIFT. As I understand, you can only do a flap procedure once.

Generally you will need the seton drain for a while. minimum of 6 weeks, average around 12, sometimes much longer. You need to fistula tract to "mature" or scar up so the sutures can have something to grab. Also you can't really have an active infection/abscess, or it will fail.

Basically, think of the fistula tract as a straw and the surgeon will, once the tract is ready, snip the straw in half. Now you have two pieces of the straw next to each other. The two ends, closest to each other are then sealed with sutures and the rest is left to heal on its own. The sphincter is not cut at all, which is why it is preferred by many CRS to avoid incontinence.

i can pretty much guarantee that if you are going to do a LIFT, you will see the seton again. If not, you should switch surgeons immediately. I don't know that you have a permanent infection. you are probably just like me, and have a fistula that seems to be in a bad location and prone to getting infected. it amazes me that some people out there with fistulas do not go through anywhere near the same amount of pain and abscessing that happens to us. I think it really just has to do with the location and length of the fistula. a lot of people who have done the LIFT have had their setons in for two to 3 months. sometimes slightly longer. for me, i had mine in for over a year before I was ready. darned thing just would not settle down.

as far as pain, it was painful for sure after day 1, but actually became pretty manageable after that, and for a few days, i would say not bad at all. again, everyone varies on this, but you've already been through the FLAP. it's generally agreed that the FLAP and the PLUG are probably the two most painful of the fistula procedures the flap being the worst. overall the LIFT for me was slightly worse than my usual incision and drainage procedure, but not so bad I needed to keep popping painkillers. I wouldn't worry too much about bowel movement pain. seriously, compared to the FLAP, where stool is passing over several fresh sutures, I think the LIFT is quite manageable. There will be pain, but nothing like you've already gone through. I think you'll be fine. and unlike the FLAP where you need to limit movement after surgery so you don't rip your sutures, the LIFT does not have those kinds of requirements. This is why a lot of CRS prefer LIFT, it generally is less painful and does not have a long a painful recovery period.

Hi Zoe, please read the paper "Clinical Practice Guideline for the Management of Anorectal Abscess, Fistula-in-Ano, and Rectovaginal Fistula by the The Clinical Practice Guidelines Committee of the American Society of Colon and Rectal Surgeons.
It describes the LIFT in detail and it is the most valid paper one can have.
In my mind there are two choices:
- Either the LIFT (which is rapidly becoming as common practice / respected as the FLAP)
- or (if it is available in your country) FiLac or VAAFT.
These are the cutting edge technologies in fistulae management today.
In terms of the seton, I believe it is recommended for - usually a couple of months - prior to the LIFT but not a requirement. Your surgeon out to be in the best position to determine whether you need it or not.
It's great that things are improving for you. You're on your way to success, i can tell.
I've read a lot of success stories on more complex fistulas (like yours and mine) and the sucess is always the result of cumulative steps. Every surgery weakens the fistula even more. In the end it loses.

Post Edited (Dimitri71) : 11/22/2017 1:58:31 AM (GMT-7)

Zoe, It's been a long time since we heard any news. You are in our prayers.
I hope all is well - All the best.

dbrookenz said...
I hope that silence on the forum means there's been success in treatment. I imagine most people move on with their lives once things are fixed up.

Hi dbrookenz, I only wish!!
Unfortunately, the fistula business is still going on.
Just saw my CRS who said that we proceed for yet another surgery (4th!) - Again cutting seton if possible otherwise FiLac- He is not yet 100% sure that he can indeed cut without the risk of continence so not able to tell for sure. Sorry to hear about all your troubles and the delays etc. Fistulas are just such a tough ailment. I am just trying to be patient but this thing is really driving me NUTS!!!

Post Edited (Dimitri71) : 4/17/2018 8:35:24 AM (GMT-6)