3rd Fistula surgery: 2nd Filac Surgery

Hey Dimitri,

That's awesome news! I'm happy you had surgery. Fingers crossed that things work out. We both know how complicated this fistula business can be! My recovery in the past 5 weeks has been up & down. I'm still draining from the external wound and I still feel like there's a fistula at work BUT my symptoms have been much less than prior to surgery and I feel a lot better in myself. I've lost the constant runny nose I had plus I'm getting to the gym and the pain & discomfort 2-3 hours after a bowel movement, while still there, is about 50% less than it was pre surgery. It's more bearable.

In any case, the very experienced nurse I saw 2 weeks ago said to me, 'These things take a long time to fix. Think of each surgery and healing process as another chipping away at it rather than a total end fix'. I think that's good advice. I really hope this surgery works for you my friend but if it doesn't then I hope it improves things a little bit more than before the surgery - maybe it moves the fistula to a position where you can get the fistulotomy or something like that.

Make sure you keep us updated on your recovery!

I understand your pain dimitri. i've been going through this for a little over two years now and sometimes i feel like i'm going backwards. at this point i guess you have to wait a little before figuring out the next step. i think it was the right call to try the filac again. now you just have to wait and see. hope this one works out for you.

Its been about 4 weeks since my last surgery. Not really sure if i'm doing better or not. ive had so many different weird secondary symptoms, muscle aches, pains, swelling around my butt,hips and thighs for the past year and it feels even worse now. probably time to see another doctor for a second opinion. the fight continues.

Dimitri,

I'm sorry to hear that recovery hasn't gone as hoped. I do know this much, anyone (including doctors) who say drainage should stop within 4 weeks is, at best, very very hopeful. From what I read drainage from successful fistula surgery can occur anywhere from 4 weeks to 6 months! It's such a complicated little beast. Personally I do feel better after my last surgery. Not in a minor way either, I'm probably 50% better in myself physically. However the same symptoms, while lessened, still remain which leads me to think the surgery shrunk the fistula but didn't quite eradicate it.

Keep your head up, my friend. Conservative procedures are the way to go. In the end when I look back at this experience I will be fine with a couple of years with many treatments AND normal continence as opposed to one radical procedure and even the slightest loss of control. Just remember, each op is slowly chiseling away. keep us all up to date with things and what might come next when you know.

Hi Dimitri,

Don't worry, no such thing as TMI! As far as I'm aware many people with fistula have fecal matter through the fistula track. Can I ask if it comes out watery or is it small specks? From what I have read it's common with fistula. Better than your body works it through and expels it. It also suggests that your fistula has an internal opening still. Unfortunately this may mean the Filac surgery has likely failed (this is my uneducated opinion so take it with a pinch of salt). Does the fistula hurt more now this is happening? I know that you didn't have much pain when your fistula first appeared.

Hi a brief update; On 22nd day now; Went through a couple of days of almost no drainage (the best in six months); However, it has resumed again, not too bad though.
Will see CRS on 15/3 (on month post op) and will update.
All the best to everyone.

Hi Newmommy, thanks for your comment. Sorry to hear you are dealing with a complex RVF. I wish I could help, but being a guy I don't know anything about it.
Thanks for your suggestion, I'm going to look into the biological paste.
To be honest, I am dealing with the fistula business for over 8 months now and I am growing a little sceptical in regards to the various spincter saving techniques..
My CRS told me that my fistula is not too complex (30% of external spihncter) so that I could do a cutting seton with very minor defects (gas incontinence perhaps)....

I am going to see him again next week and have to discuss all this in case FiLac does not work...

Hi all,
saw my CRS to update post 1 month.
The fistula has not closed but he said it is now "superficial and does not involve a lot of sphincter".
He told me to wait until April 20th and if it doesn't heal, then go for a cutting seton operation.
So, I guess that's good news since my CRS is super careful about continence. He said he is not worried about flatus incontinence either "none of that". So overall great news some light at the end of the tunnel.
Hi Kerry90, I'd be verry happy to help and provide with any info you need. I will send an email once you have included your email in your profile, because I don't have it.
All the best to everyone, Dimitri.

Hi Memmem good to hear from you!!!

As I understand you currently have a draining seton which has more or less eradicated the main fistula? No need for a VAAFT anymore? That's great news.

In terms of the other opening it sounds like a superficial extension of the main fistula (no internal opening connection) or like a sinus which has been created through the rubbing of the seton. I had something similar in the beginning of this saga and my CRS laid it open during my first operation (July 2017) and then it healed. My fistula is also at 12'o clock and the extension was heading towards the same direction, so sort of scary to put it mildly! My CRS told me at that time that this would be no problem and he was right, it has stayed fully healed since that date (mine was connecting to the external fistula opening at skin level, very superficial).

Thanks about the story with your uncle, my CRS told me the Cutting Seton will stay on for 15-20 days. He did not tell me about rotating it, but we'll go into more details on April 20th when I'll meet him. I thought about the MRI as well to be honest (I had one and a 3D ultrasound as well during 6/2017) Its fairly easy to get an MRI in Greece and not too expensive.

However, prior to my 2nd Filac I went and consulted another prominent CRS (CRS B) who suggested that my fistula was "simple, like I cought a cold" or something and that he could easily perform a fistulectomy. I suggested an MRI to him and he said "no need, in case I see something strange during the operation, I'll perform an 3D Ultrasound on the spot, which is better. However this is simple, don't worry".
Following this visit to CRS B, I realized that my fistula was in a better shape than it had been prior to the first operation, possibly due the distalizing achieved by my first FiLac (or the draining seton) and the good job that my CRS A had done with cutting the fistula extension.

So I decided to go for another FiLac with my CRS A...And post this 2nd FiLac surgery, CRS A who is very-very careful in regards to continence, says the fistula has now become very simple and superficial. I asked him about continence problems and he said impossible...He also thinks that MRI is useless for my case. But I get your point, better safe than sorry...I may call him over the phone and ask him again (instead of directly confronting him with it and going into discussions).

CRSs are a creature of their own. For example, CRS A will not cut, he simply uses cutting seton, even for more superficial fistulas. CRS B suggested a fistulectomy...Really, the fistula business is very strange...And we pay to be guinea pigs!!

Post Edited (Dimitri71) : 3/17/2018 3:08:51 AM (GMT-6)

Hi Memmem, I think draining pus and other gross staff (while having a draining seton on) is absolutely normal. That's what a fistula does....

I don't think you need antibiotics unless you have an asbcess (even then the only cure is I&D, not antibiotics).

I have been only prescribed antibiotics for a week (immediately post surgery). So ask your CRS prior to taking them since you may not need them. If the fistula drains you cannot get sepsis.

Good luck with your op in one month. VAAFT is great, in my view possibly better than FiLac since they visualize the fistula with a camera.

Again, I have become very sceptical of the sphincter saving techniques and their supposed success rates. I am sure there is a selection bias in terms of the patients. Otherwise how can you explain the big deviations on various studies and their results (concerning both for FiLac and VAAFT);
In any case, even if they fail, both FiLac and VAAFT "distalize" fistulas (that's the term they use to describe that the fistula involves less muscle and becomes more superficial).

As a result - worst case scenario - you can apply successfully the most "ancient" methods.
In case a fistulectomy or cutting seton was not absolutely safe, I would persist with VAAFT or FiLac.

Hi Memmem, great news, you really did it very quickly!!! Hope you get a speedy and full recovery.
Great to have this assortment of VAAFT and FiLac.
Both are good methods to kill the monster, or at least slowly, yet surely get the fistula exhausted!!
All the best and Keep us posted!

Wishing you speedy and complete recovery Memmem!

Dimitri, sorry I fixed that now so my email should show up on my profile. Thank you for providing all this information about your experience!

You are right about patience Dimitri,its better to leave it to time and see how it pans out,than to constantly trying to figure it out..i think I did have a fistulectomy meaning csr cut until where it comes close to sphincters and he used laser after that.He used the term Pit excision for that..I will ask him when I see him in a week,I am pretty sure he knows what he is doing but never hurts to know.

Post Edited (Memmem) : 3/27/2018 8:03:29 PM (GMT-6)