Fistula and setons

So this is just information from my experience with my RV fistula and setons, and what fistula surgery options there are (most specifically for RV fistula but can be adapted). I'm making this a new thread because I have been answering this question a lot, so next time I can find this easier and then just copy and paste (lazy, I know).

Since I do have Crohn's, my surgeon's method of dealing with it is a bit different than how it would be if I didn't have Crohn's...I think. You have a few options. First, I would make an appointment to get in to a colo-rectal surgeon. A general surgeon is probably not the best way to go. When I first had mine, I met a regular surgeon and he told me that if any surgeon tries to tell me that they can handle it and I don't need a special colo-rectal surgeon, to run away and not look back!

Here are some of your options (at least, these were my options with Crohn's).

***have a seton put in. Setons can be left in indefinitely. They are kind of like a rubberband/plastic-y stitch that keeps your fistula open. For mine with an RV fistula, this is how it worked: So think of a seton drain like a piercing.....only with a rubber-band/flexible plastic thing instead of metal. Like the material they use with stitches, kind of. The problem with a fistula in addition to stuff passing through is that if one side heals up but not the other side (it's a very, very short, thin tunnel between the anus and vagina) then the stuff will pile in and create and abscess and break through again. It's not a fun cycle. I'm not sure if this how all RV fistulas go (mine is lower), but they took the "string" and thread it up the anus, through the fistula, and out the vagina. Then the ends are tied on the outside. The fistula heals around it, like a piercing. That's why it can be there indefinitely, not hurt during intercourse, etc. It mostly plugs up the fistula so I rarely have gas or stool pas through unless I try to hold a lot of gas in or I have diarrhea, and even then, it's not very much.

***have a plug surgery. This is a very easy, low-problem surgery. If it doesn't work, then it's okay. They take the seton out (if you had one in) for a few weeks. Then they have this mesh-like plug that they stitch in with dissolvable stitches. The mesh is made of something that stimulates skin growth and hopes to encourage the fistula to heal together naturally. As it heals and the stitches dissolve, the plug falls out. If it doesn't work, you can try it again or you can just put the seton back in. There is very minimal risk involved.

***have a graft or a flap surgery. This is the big one. You take a graft of skin from somewhere (my CR surgeon suggested the labia), or take a slice of skin near where the fistula is and fold it over, and cover the fistula on each side. Then you sew the graft/flap on. There is a big finality with this surgery, though. If you do it and it doesn't heal in about 6 weeks, then there's no way to undo it and put a seton back in. Instead, you will need to do a temporary ostomy until the fistula heals (so indefinitely). The problem with that is that (with Crohn's disease especially), they cannot reattach the intestines to reverse the ostomy surgery if there is any kind of active inflammation. Since with Crohn's inflammation is common, then that is tricky and frustrating. Also, with the surgery, your intestines will probably inflame just from the surgery and not from Crohn's, but you still can't be re-attached.

As you talk with your CR surgeon, he'll help decide what's right for you. If you don't have Crohn's, I think your best bet would be the plug surgery. I had that last August, but mine was unsuccessful because it had been so long since the fistula formed. It's now kind of like a pierced ear - even though the earring is out (I no longer have a seton), the skin around it won't close the hole because it's all healed up. But since yours sounds new and you don't have the Crohn's damage (I'm guessing), then a plug seems like a good option. If it doesn't take, then you can still explore other options.