Advancement flap for anal fistula - My experience

Thanks Dimitri, your encouragement means a lot to me.

I am now 2 weeks and two days post op and things are looking brighter. My posts above show how despairing I became when symptoms very similar to pre flap operation returned and I thought it was a failure. Since I had my mushroom drain taken out from the external wound site my fistula has drained almost nothing. In fact, from the external wound it hasn't drained anything bar tiny amounts of clear serous in five days. It's never gone longer than a few hours without thickish yellow drainage. This is extremely heartening.

I still get very small amounts of yellow drainage from my anus in the hours after a bowel movement. It's not thick, and I don't think it's pus, and usually mixed with small amounts of watery fecal matter. Again, it's a tiny amount but enough that I still wear guaze every day. I am hoping it's just mucus and with more healing time that will stop too.

The thing that concerns me most right now is the ache I get after a bowel movement. It usually lasts from the minutes after I use the toilet and for the next two hours. It's not nearly like it was with my fistula and it's noticeable and makes me want to sit down rather than stand. On a pain level, I'd say about a 3/10, annoying rather than sore.

I know the flap is a pretty brutal surgery on the inside of the rectum and I also know that each time I have a bowel movement I am covering a tender internal area with fecal matter (not exactly the best thing for healing!). Can anyone tell me how long it took them to heal after anal surgery? Does the inside takes months before you stop feeling any discomfort and pain after a bowel movement?

I should also add that i still suffer VERY minor gas incontinence. It's hard to explain - I can hold in most gas 95% of the time but very small amounts sometimes just come out 1-2 times during the day. I really hope this stops, once the inside of my anus is healed properly.

Thanks for the support everyone. I remain cautiously optimistic.

Thank you so much Dimitri, you don't know how much your support has meant to me since I started coming on this forum. Even just your calm words of wisdom after you healed yourself were much appreciated.

I have gone another two days without any drainage from the external wound. I also just FEEL better down there, if that makes sense. I definitely still get discomfort post bowel movement but it's feeling less significant every day and even though it's a bit achy and uncomfortable it feels like a healing ache rather than a fistula ache.

I am still getting that yellow drainage from my rectum but it's getting less and less and I think you're right, it doesn't look like pus. I hope the minor gas incontinence that you mentioned we both get goes away with time. I know that minor incontinence of all types can often be cured with exercise of that region and time for that area to heal.

I still remain cautious but my despair of last week has left. Even if this is not the slow but steady end to my nightmare then at least it has definitely changed things down there and if I need more treatments then hopefully it will make it easier to get rid of.

To anyone reading this, please keep in mind that these things take a long time to heal. My idea that the flap would be stitched down and the internal area would resolve itself after a few days was ridiculous. Fistula in ano is a disease of sorts and like most disease, your body takes a while to fully get rid of it after you start treatment.

Keep the faith!

Ha ha, all those life issues seem to pale in comparison when your health is at stake!

It's been three weeks today since my advancement flap operation. I'm still experiencing an ache after a bowel movement. It's not like it was pre operation, but it's still there and stays for an hour or two after a bowel movement. I am really hoping it's just due to my internal healing. There is almost no information out there on how long the inside of the anus takes to heal following surgery. The inside of my anus sometimes feels quite tender as well. it's hard to describe. Some days I feel 100% down there and other days it feels a bit 'off'. Not in a fistula sort of way but a dull achey sort of way.

My external site has no drainage bar tiny amounts of serous which keeps m e optimistic. At this point it's just that ache that concerns me but I've had my fistula for a whole year, and given the flap is fairly invasive, I'll give it more than 3 weeks before I get too concerned. Even if the fistula wasn't entirely cured, my op definitely improved things so if this isn't the end then it's a big step towards the end.

Hi DBrookenz, don't rush into conclusions just yet. You need to assess the situation with a professional. I believe it's too early to draw conclusions though. Overall you could have draining for 6 weeks post surgery.
In any case it would be good for yo to call your CRS, and follow up on progress.
The CRS will help you obtain a general overview of where things stand.
Alll the best and keep fighting DBrookenz.

Post Edited (Dimitri71) : 10/12/2018 7:22:05 AM (GMT-6)

Hi ktseatac,

Sorry I've taken a while to reply. I had to step away from online stuff as it was making me depressed and obsessive. I'm really sorry to hear about your flap experience. Please take my thoughts with a grain of salt as I'm not a doctor nor do I know all details of your condition. Your specialist will always know better than some chump on the internet!

Taking that into account, and going by my own personal experience, it sounds like your flap surgery has failed. It's identical to my experience post op. I think the flap has an official 70% success rate, and many of those who have a failed flap operation also have other issues, yet the internet is littered with people without chrons who have had a failed flap. My gut feeling is that the flap is more of a 50/50 success or fail. I wish I had of known that instead of expecting it to work first time around!

I am still battling my fistula. It's been a long and horrible journey. After my last failed flap, my specialist inserted another seton. There's quite a long wait between surgeries as I'm a public health system. It's not all bad news though. This seton was initially painful, for about a month. Similar to all my other setons. However, the pain lessened a lot and has been about a 3-4 out of 10 post bowel movement for a few hours most days, as opposed to 7-8 for the past year and a half. It just FEELS different. I get the odd bad day but otherwise it's better. I still get drainage every day but it's minimal. I have a surgery soon for another advancement flap. My specialist initially was talking about stem cell treatment but now he wants another AF and said the stem cell treatment is more of a 'when all else fails'. I'm pretty zen about the next AF.

My advice to anyone getting a seton is to give it time. try and tough out the first month or two. Your body will adapt and it will get better. For anyone getting the flap, don't expect miracles and try to be zen about it failing. In the end it's still better to try cure it incrementally with loads of failures before success than to go nuclear with the lay open technique and leave you incontinent for life. It's such a delicate area to work with that surgeons just take the low risk, high fail options as much as possible.

How are things with you now?

I find myself so “envious” of you guys who live outside of Canada & can get this surgery. Not that I want surgery.....but this ridiculous rollercoaster of abscess I & D’s is simply unfair. I have yet another abscess & will at some point be having my 13th surgery. Crazy thing is I’m in firm remission. Last I & D recovery was so brutal & took 6 weeks. There wasn’t any drainage either. Quincy may have found someone in another province who actually repairs fistulas for CD. I haven’t got the courage to contact him yet for fear of another dismissive response. Tbh also really busy working & that is keeping my mind off of disease, which has been really, really nice.

Hi DBrookenz, well done! For sure you do not have a fistula, because you cannot have a fistula with only an internal opening. A fistula is by default a tunnel with two openings!
I also had some yellow drainage when the external wound healed and it came from the rectum (due to the surgery it may leak from your bowel until the skin heals, so some minor incontinence is normal).
Have you tried getting rid of the gauze and see if your underwear is stained? Also, you may be placing the gauze too high up.

Post Edited (Dimitri71) : 11/23/2019 9:50:15 AM (GMT-7)

Hi DBrookenz, good to hear from you also; overall life is great, enjoying my family, no fistula since May 2018, so the cutting seton did it.
Of course the fistula adventure is never forgotten and there is always that lingering fear that it may come back.I now only wash myself with water after a bowel movement because I really don't want to irritate/scratch the area. At work I have wet wipes.

In terms of incontinence, I have a somehow lessened ability to hold myself and some urgency (e.g. if I feel that get a diarrhea I have to go faster than I use to). But no daily drainage or anything of that kind, so any incontinence is overall minor.

What you describe (post BM) maybe some form of minor incontinence and it may improve over time; Check with your CRS to make sure though. All the best and keep us posted DBrookenz.

Post Edited (Dimitri71) : 11/27/2019 6:45:06 AM (GMT-7)

Hi Taca,

I know drainage after surgery is common and I wouldn't jump to any conclusions just yet. However, if the drainage doesn't decrease after 5-6 weeks then it's possible the flap failed. One of the things I found hardest was my almost obsessive watch on my drainage day to day. if I had almost none, I felt elated. Then I would get a lot the next day and I would slump. Please try distract yourself and look at things long term rather than short term.

I'm not sure where I stand right now. My external wound has closed up, looks healthy on the outside and has been free of any drainage for about 3-4 weeks. I'm currently 8 weeks post op. I also get no pain or throbbing in that area. It seems like the internal fistula has stayed closed. Great!

HOWEVER, I still drain yellow form my anus. Not a large amount but enough to warrant a tissue there through the day. I also still get a strange feeling inside my rectum after bowel movements. Not pain, but slight discomfort. I also get a lot of gas towards the afternoon & evening. It's not like regular gas, almost like it's air bubbles that need to escape. I'm quite confused as to whether this is a healing process or something is still going on inside my rectum. Perhaps 8 weeks is chump change when it comes to healing the inside of your rectum. perhaps it will take 6 months or more. I did have my fistula for two years prior so there's likely a lot to heal.

I'll report back after my specialist appointment in January. If I still have a fistula then it's back to the drawing board!

Ah okay, they are two quite different operations! I had a LIFT too, which failed. From all my reading, the flap and LIFT have a similar success rate, though I think flap is still seen as more of a gold standard that LIFT. I think many choose LIFT because it's relatively low key with recovery compared to the flap. Weird thing with me was that I found the LIFT far more painful than the flap.

It's definitely too soon for you to know it it worked or failed. Just try to get on with life and reassess each month. I'm still super confused by my situation. External site seems great, no drainage and I have no pain at all. However, the small amount of yellow drainage from the anus continues and the gas issue remains. Keep us up to date with your recovery!

It was the usual 4-6 weeks before I knew the LIFT had failed though in hindsight I had weird pains and discomfort after 2-3 weeks that were probably a sign surgery had not worked. Also, drainage from the external never stopped.

As it stands now, my external wound has closed and I have No drainage from the external site & almost no pain or discomfort, just very small leakage of mucus over a day from my butt. I’ve learned not to get my hopes up but I’m feeling great for the first time in two years.

Yes, please keep us up to date with your recovery. Hearing if others experiences was a mental lifeline for me over the past 24 months!

As it stands, I’ve had approx 3 I&d, 3 seton operations, 1 failed LIFT, i successful staple op (on a very high up internal opening). and 2 failed Advancement flaps. I BBC was told this could be a long journey but I wasn’t prepared for that! For the record, I don’t have chrons.

Hi dbrookenz and congratulations, I am very happy for you.
You can also do some sitz baths, water and salt no rinsing after, that helps the wound heal even faster.