Advancement flap for anal fistula - My experience

DBrookenz, my friend, I hope this one works out, you have been through a lot.
You are a real fighter, I am 100% sure you will do it in the end. No doubt.
Sending my support and crossing my fingers for you.

Day 4 - pain isn’t so bad today. In fact it’s minimal at best. However, have a strange sensation inside my anus, where I’m constantly feeling like I have to poop a bit. It’s all from my anus, no stomach issues or anything. I know the flap uses dissolving stitches so maybe just having for foreign objects in there, plus swelling from the surgery site, gives the sensation of not having emptied. I wonder if this is the norm for many anal operations?

I don’t have any drainage or pain post bowel movement, like I did pre op, so that’s great news. Taking things easy at mo but back to work soon as I can’t afford more time off. Luckily it’s not a labour intensive job. Things seem to be on track so far but 5 days is way too early to tell anything! The flap is a pretty brutal procedure, that’s for sure.

Hi DBrookenz,
good news you have no puss, and only slight drainage. That's very positive.
In regards to the discomfort you feel, sounds normal.
Every wound in the area takes forever to heal. Plus post surgery it takes about two weeks to get your normal BM "habits" back...Maybe anxiety, maybe all the medicines etc.
All the best.

Thanks Dimitri, I really hope it's a good sign. Just taking each day as it comes so far, not getting ahead of myself (I learned not to do that after my last surgery!).

Octobergirl, yes I have a high fistula. It involves way too much sphincter muscle to do a simple fistulotomy. As for recovery, I'm not sure how long it takes - a bit like how long is a piece of string? - but from the stuff I've read they know whether the flap operation was successful after about 6 weeks. At this stage the external opening will have reduced enough for them to tell.

Exercise is a tricky one. My doctor told me to take 10 days off work but I couldn't afford to do that, so took 5 days and came back on the 6th. I'm lucky in that my job is a bit of walking around but not much else, so nothing too strenuous. I would avoid all real exercise for at least 4 weeks. Definitely no weights or running. The idea is that the flap is given a chance to heal without being aggravated. However, part of what makes the operation succeed is helping blood flow to that area, which walking and moving does. So I suspect movement, when you're physically ready' is a good thing.

Don't forget, fistula surgery varies for everyone. Our experiences are all different. Some of us get better quickly, others have pain for weeks. The surgery itself involves cutting out a flap from inside your rectum, then stitching it over the internal opening, and coring out the external wound. The pain I've had so far, while very uncomfortable, isn't nearly as awful as that description would suggest!

A quick update - day 6 and the discomfort in my rectum has eased quite a bit. I still got woken up last night from the discomfort but it no longer feels like I'm needing to poop. I still feel very tender and raw 'down there' but it's a little better each day and no weird shooting pains like I had when my fistula was active. I also have very little drainage, almost nothing from the external wound and just a very small amount of light brown watery stuff from my anus. In fact, it's the least amount of drainage I've had since I got the fistula a year ago, so I am cautiously optimistic. I am pretty regular with my bowel movements, which usually happens in the morning before work. I'm a once per day guy. I've noticed that hasn't changed but my ability to 'hold it in' before that morning movement has become less. Not in a worrisome way, but I just feel more pressure to get to the toilet once that urge kicks in. I hope that will settle down a bit once that area has recovered more from the surgery.

Post Edited (dbrookenz) : 9/25/2018 5:59:50 PM (GMT-6)

Day 7 - UPDATE: I was about to finish work today and I checked the guaze between my butt cheeks, to help with the drainage post surgery. Up to now it's been mostly clear, with a slight pink hue sometimes. Also some very small amounts of light watery stool liquid. I didn't worry about the latter, my rectum has been through trauma and it happened last time I got surgery and went away within a few weeks.

However, today was the first day I've had a very small amount of light yellow. Again, it's a tiny amount, and it's not thick like pus would be, but it reminds me of some of the drainage from my fistula pre surgery.

Is yellow coloured drainage normal even when a fistula has been closed internally? My CRS said that he closed the internal opening with the flap, but that there was a reasonably big cavity left where the fistula tracked, which is why he put in a mushroom drain to keep it draining and not healing over the external opening. Can anyone share their post fistula surgery draining stories?

Dimitri - I know your fistula closed up but did you still get drainage during recovery?

Thanks Dimitri for your quick reply. Even though the inside of my rectum feels very sore, it's not fistula sore, if that makes sense. More like bruised and battered sore. I guess my spirit just dropped when I saw the small a mount of yellow drainage today as I associate that with fistula drainage and my immediate thought was that the flap had failed and the internal opening had burned through the flap or something.

I'm going to try stay positive. It's been one week since my operation and I think I'm doing pretty compared to others who have had the flap operation.

Thanks again for your support my friend.

Hey Octobergirl,

I should say first up that I don’t have chrons. However, pretty certain I’m an undiagnosed IBS.

My advice to you is to talk with your CRS. I had a draining seton inbefore my operation and it got to a point where discomfort was minimal. I could live a pretty normal life. Only problem was drainage every day. As we know, A fistula won’t close without further surgery. If fistulotomy isn’t an option then there’s three common alternatives, all designed to avoid causing incontinence. Flap, lift and cutting seton. From my reading, flap has highest success. I’ve also read that the cutting seton has the highest possibility for minor incontinence. Having said that, Dimitri above had it successfully done on a fistula.

The flap has a pretty high success rate with chrons patients too, around 50-60%. I know they can do a follow up flap if it fails in a non chrons patient, not sure for chrons. My crs seemed to suggest a cuttin seton was more of an option down the track. He wasn’t big on the LIFT either. They’re all different though. No one right answer. By the way, it’s a GOOD thing your CRS is conservative. Any damage down there can not be undone. Better to take treatment slowly nd cautiously. I used to be so impatient to get rid of this thing but I’m more philosophical now, a year later.

Day 8 - was quite sore last night. Eased while I slept and woke up okay, but gauze had more discharge on it than previous days. Seems like it came from inside my butt, not from the external opening of fistula. Hopefully all part of the healing process inside. I’m just trying to be zen about it now. If it works, great, if it doesn’t then I have more options.

Thanks Octobergirl, and keep me up to date with what happens your way. It’s a long process, these darnfostula, but it WILL end. Stay positive. Badger your CRS too. My CRS is a good guy and knows his stuff, but I suspect a fistula isn’t at the top of his seriousness list if you’re managing to get by with it, and I think they need a reminder how troublesome it is for us!

I’m pretty good today. Relatively pain free, minimal to no drainage so far. One thing that I’m puzzled by - the draining seton should ease inflammation and then the flap covers the internal opening, but does that mean the fistula, or the source of the infection, just turns off or burns out straight away? It just occurred to me that the infection, while not being fed by bowel movements any more, may take a while to go away especially since it’s bern there for a year.

I’ll post an update next week on recovery and drainage after I get my mushroom drain out.

Day 10 Update - I don't want to get all doom & gloom but I think my flap has failed. Yesterday and today I got a familiar ache inside my rectum after my morning bowel movement, which lasts for about 2 hours. It's not unbearable but it's uncomfortable. I am desperately hoping that it's down to fecal matter passing over tender areas that are still pretty beat up from surgery (the flap is pretty brutal on the inside of the rectum and ten days is hardly time for that area to heal up) but I noticed that there was a small amount of thicker yellow liquid that appeared from my external opening just now. This was the usual routine before my advancement flap. I know that yellowish discharge draining from a healing fistula is normal, but my mind leaps to worst case scenario of course.

I know it's too early to tell yet so I'm trying to stay optimistic. Weird thing is, I had no passing of blood post op, or if I did it was a very small trace the day after the op, and most people I read who have a failed flap say that when it doesn't take there will be blood? Otherwise I don't really get why it might fail, other than the fistula infection at the internal opening eating through the new layer that's been pulled over to close it inside?

Thanks DCChrons, you’re absolutely right, patience is tough. I’m so used to pain down there and drainage that I associate it with fistula. I need to realize that the fistula will still drain for a while, even if the internal opening is closed. It’s hard to remain upbeat though when symptoms and drainage resemble what I had before the flap operation. Once I saw some thicker yellow discharge from the external opening this morning after the bowel movement pain I almost had an anxiety attack.

This has been an utter nightmare and, from the looks of things, seems to be continuing.

Thanks for your support.

Post Edited (dbrookenz) : 9/29/2018 6:13:38 PM (GMT-6)

Thanks Dimitri, but I’m all but certain it’s failed. I get a couple of hours of pain after a bowel movement, plus it drains more yellow discharge too. Basics feels like the exact same symptoms as before the flap. I know it’s very early but I know my body and tbh it actually feels worse than when I had the draining seton, plus I’ve noticed that I occasionally can’t hold small amounts of gas, which I REALLY Hope is just temporary while my rectum heals and is still swollen etc.

Guess I now have to wait 6 weeks to have my follow up. This is just a nightmare that won’t end. I think I’d rather just have a seton and be done with it all.

I’m not sure exactly but I do know it’s quite high in the rectum and goes through a lot of muscle. Thanks for your advice, it means a lot. I’ve had three ops, not including two seton ops and I just feel like I’m done with it. The last MRI they gave me showed a single opening. I’d hoped the flap would fix that. Oh well, back to square one, with pain and drainage post bowel movement every morning. I might enquire about cutting seton in 6 weeks, or the lift.