Fistula Seton Stitch Advice

Hello

Welcome to our little corner of rainbows, unicorns, puppies and also diseases and other good stuffs. Sorry to hear you’ve not had much info from your surgeon. Not surprusing with NHS these days.

I’ll try to answer your questions as much as my knowledge and experience allows. I currently have three draining setons for a complex fistula. Have had them for over two months. I also have Crohn’s disease and it’s absolutely imperative any underlying condition is treated along with the fistulas.

Now to your questions:

1. Depends on if the fistulas has healed. Yoy’ve not mentioned any underlying conditiins so it’s possible. For CD it’s often there for years. But changed and cleaned regularly. Your surgeon should have asvised if it’s a check up or removal date, sorry.
2. You will no by the drainage changing (cour, texture), decreasing and eventually stopping.
3. Hmmm I’m not sure, others will advise though. I know mine will be eventually removed under GA as they always reexamine and change/remove them under GA.
4. Yes! sounds like the knot might be bothering the entry site. You can try moving it gently out. Hot shower/bath makes it easier. Only one of my three setons still gives me some pain when it rubs or gets stuck. I have a ladybits fistula though so slightly different.
5. You definitely can but the question is whether it’s a good idea or not. Tbud againdepends onj derlying conditions and why the seton is in in the first place.
6. Well... keep it clean and dry but there’s not much else you cando unfortunately.

Oh btw, I find it rather strange that there’s no check up scheduled for you in a month’s time. Like with other minor surgeries. Might be my experience only.

Happy to read your story if you’re willing to share.

Hope you soon feel better with your temporary friend.

Hi Newmommy26 and Dimitri71,

Thank you so much for answering my questions, has really assured me that things will be okay. I'm not actually sure if I have a drainage or cutting seton, i'm assuming the former because there was no mention of tightening, thankfully I managed to arrange an appointment on the 23rd of this month, hopefully he can give me some more clarity...

In relation to the draining seton,will i definitely have to go in for surgery again or is there a chance that the fistula will heal without second stage surgery and it can just be removed? I was under the impression that I just get the seton removed two months later... It feels as if the fistula is healing well, the drainage is stopping and I can feel the open wound shrinking, or is this a bad sign just 5 days after surgery? I work as a business development manager and when I go back to work I will need to be travelling a lot and attending lots of meetings but I'm very worried that I won't be able to cope, I go back on the 22nd...

I don't have Chron's, just a fistula, sorry to hear you have this newmommy26, how does this change things?

This all started about 3 years ago when I noticed a lump and a tunnel leading to you know where... it wasn't causing me any pain or problems at all, only swelling for short periods and then shrinking again so I just left it alone. Then about a month ago the swelling was much worse, still no pain but the swelling was bigger than normal so I went to the doctors who recommended I get it removed, again this wasn't causing me any issues but after surgery I am getting lots of pain, so kinda regretting it in a way... Is it normal to get an extreme stinging pain after bowel movements? The only thing that helps is a sitz bath (so glad i bought one after reading other's stories), will it ever be comfortable to sit down on a normal chair with this seton stitch?

All the best.

After much pushing I managed to arrange a phone call with my surgeon, hopefully others find this useful, he said:

After 6 weeks (post-op) we will look at the fistula and seton stitch to determine if it has healed well, if so then you have the following options; (1) remove the seton and leave to heal, (2) tighten the seton, (3) remove seton and place plug or glue to seal tract or (4), leave the seton in for 6 months and then perform surgery to repair/remove the fistula completely.

If the fistula hasn't healed well then they will leave it in for a further 6 weeks.

He did say that this is all completely up to me, so if it's the case that it has healed well after 6 weeks then I will request to have it removed and hope that it heals by following a healthy diet, 80% of success with this option.

Hope this helps someone

Hi Normanski,

I've had an anal fistula for the past year and in that time I have read up about so much that my specialist told me the other week that I know more about anal fistula than some of his med students!

Take what I say with a grain of salt as I'm just going by the research and info I've read but in most cases a fistula cannot just heal on it's own. That is to say there needs to be secondary surgery to the draining seton. A draining seton is there to keep an abscess from forming and to 'burn out' the infection for the follow up procedure. A cutting seton is a different story as it slowly works through muscle in a safe way to preserve continence while destroying the fistula track in the process. However I am pretty certain you'd know if you had a cutting seton as, from what I have read, they sound quite painful.

My experience was that I developed an abscess near my anus that got sore and gave me fevers. I got it drained twice but they didn't find an internal opening until the third EUA. The specialist told me that it was a high fistula, which meant they couldn't perform a Fistulotomy, which is an easy and successful surgery that they do with low fistula. I got a seton for a few weeks and then my specialist performed an 'advancement flap'. I have also just had another ope to close a small opening in my rectum.

If you have a high fistula, which is likely given you have a seton, then you have a few options. There's the Advancement Flap, which worked for me but should be done by a skilled colorectal surgeon. There's also the LIFT procedure which is a new and seemingly successful procedure that is gaining in popularity. Both these surgeries have about a 70% success rate but I suspect it's higher for people who aren't suffering from churns or other ailments. From everything I have read the PLUG procedure has a low success rate and seems like it's on the way out as a colorectal specialists 'go to'. Definitely ask lots of questions and get a second opinion.

I should also add that you're usually good with a draining seton. Many people on this board live with them. It will keep drainage going and usually be of little discomfort. There is no huge rush to get a procedure done in my opinion so if you have to put it off a few weeks due to work commitments then that shouldn't be a problem. I think they mostly take a seton out under anaesthesia but I have read some people who had it taken out without being put under.

Good luck my friend. Healing a fistula can be a long and frustrating road but as a friend of mine on this forum often says, the fistula WILL lose in the end and see each phase as another step in eradicating it.

Hi hld4good, thanks for letting us know.
Did you have incontinence issue because of the cutting seton?

That sounds really horrible. But as I understand it did not leave you with any permanent incontinence issues, right?

hld4good, I see your point, he ought to have warned you.
On the other hand, you know, your surgeon did a great job at the end of the day! And as all of us have already figured out, CRSs are not renowned about their communication / coaching skills.
Great story though and very encouraging at the end of the day.