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Crohn's Disease Forum » Surgery » Fistulas, Fissures and Abscesses » Surgery for Rectovaginal Fistulas



03-11-2013, 02:49 PM   #1
Misseireann
 
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Surgery for Rectovaginal Fistulas

Hi All, I hope this email finds you well. I'm in remission (THANK GOD!) from crohn's, but I am scheduled to have surgery at the end of June to repair the recto-vaginal fistulas that I have had for over 2 years. My surgeon is going to perform a gricilis muscle repositioning flap... has anyone ever done this? It will be my 4th major surgery in 5 years, and I am NOT looking forward to it.

I have a j-pouch... my original diagnosis was ulcerative colitis, and 3 years after my colectomy, I was diagnosed with crohns. UGH. This disease is never ending!

I was also wondering if anyone knows whether or not that the pH necessary to get pregnant can be affected by fistulas. I'm hoping if so, that the surgery will correct any issues that we might have.

Please give me as much info as you can about this surgery! I don't know anyone who has had this surgery, and I'm very nervous at the prospect of anything going wrong (my last surgeries were kind of disastrous, to the point of nearly catastrophic with sepsis and blood clots).

Thanks so much!

Erin
03-13-2013, 05:28 AM   #2
xX_LittleMissValentine_Xx
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Good luck with the surgery!
I haven't had this particular surgery but I did have successful fistula surgery in Jan.
I Hope it works out for you x
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03-14-2013, 09:27 PM   #3
Jennifer
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I'm not sure if these are the same surgery but they may very well be similar. I did a search for Fistulas, surgery and flap and got some hits. There's more than just these few threads though.
http://www.crohnsforum.com/showthread.php?t=10063
http://www.crohnsforum.com/showthread.php?t=2921
http://www.crohnsforum.com/showthread.php?t=29296

As for your second question, "if anyone knows whether or not that the pH necessary to get pregnant can be affected by fistulas," I don't know so I'm going to tag Judith just in case she might know.
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Currently in: REMISSION Thought it was a flare but it's just scar tissue from my resection. Dealing with a stricture. Remission from my resection, 17 years and counting.
03-14-2013, 09:44 PM   #4
Misseireann
 
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Thanks so much, Jennifer!!
03-16-2013, 07:19 AM   #5
Jaano711
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Good luck with your surgery. I had a recto vaginal fistula that just wouldn't heal. I think it was present when I fell pregnant with my 3rd child. I didn't have any problems while pregnant. I do however think that at that stage it hadn't been diagnosed, but boy oh boy I was passing wind from the fistula, and my surgeon(at the time) did not believe me.
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03-16-2013, 10:35 AM   #6
Misseireann
 
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Hi Janette, did you have surgery after your pregnancy? I totally understand the passing of the wind and other nastiness from the fistulas. I'm a teacher and will have to periodically excuse myself from the room or just hope that no one comes near me for a little while, hehe.

Thanks so much, Erin
03-20-2013, 02:29 PM   #7
Judith
 
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Hi All, I hope this email finds you well. I'm in remission (THANK GOD!) from crohn's, but I am scheduled to have surgery at the end of June to repair the recto-vaginal fistulas that I have had for over 2 years. My surgeon is going to perform a gricilis muscle repositioning flap... has anyone ever done this? It will be my 4th major surgery in 5 years, and I am NOT looking forward to it.

I have a j-pouch... my original diagnosis was ulcerative colitis, and 3 years after my colectomy, I was diagnosed with crohns. UGH. This disease is never ending!

I was also wondering if anyone knows whether or not that the pH necessary to get pregnant can be affected by fistulas. I'm hoping if so, that the surgery will correct any issues that we might have.
Erin,
Best of luck with your surgery and I wish you all the best with your future pregnancies and family members.

A rectovaginal fistula can absolutely affect the ability to get pregnant. However, women have become pregnant with them so it should not be relied upon as birth control. Not only could it change the pH in the vagina but can also cause recurrent vaginal infections and introduces bacteria that should not normally be present in the vagina. The vagina is supposed to have a normal balance of bacteria but not the type (and quantity) that are present in the GI tract.

The introduction of bacteria, skewed pH, and infections will cause an increase in activated immune cells present in the vagina. These overactivated immune cells can attack sperm cells before they are able to combine with the egg.

Implantation of the newly fertilized egg into the uterine wall and subsequent growth of the embryo requires an *extremely* delicate balance of Immune cell functioning - between the "Protect the body" and "Allow the embryo to grow". The embryo is technically a "foreign" invader so the immune system is tuned to destroy it by default. The embryo is tagged as foreign because approximately half is from the male contributor and will not be recognized as "self" by your immune system. During the earliest stages of pregnancy your immune system "allows" this foreign embryo to take hold and grow. It is an extremely complex process. If the immune system is trying to clear material that enters from the fistula, it is less likely to "allow" a foreign body (the embryo). The immune system may attack it directly, or simply increase the thickness and composition of the mucous.

I don't know if you have ever noticed but around ovulation, the cervical mucous gets thinner and more slippery. In fact, it's composition changes quite a bit. The "Ovulation type mucous" allows the sperm to travel through it more easily so they can reach the egg. However, it can allow other material to enter more easily as well and increases chances of infection so the presence of this type of mucous is minimized to a very short window.

During non-fertile periods the cervical mucous completely changes composition. It becomes thicker and more sticky and becomes less penetrable to sperm and other foreign material.

One of the major (and effective) defense systems of the body includes increased (sticky) mucous production when a foreign invader is suspected. You can see this when you have a cold or allergies = mucous. The female reproductive tract has a similar defense mechanism, especially in the case of rectovaginal fistula.

Once that has healed, the immune system should calm down. I would expect it to take a couple of cycles though for things to get back to normal.

Sorry it is such a long post. I wish you all the best.
03-20-2013, 04:24 PM   #8
Misseireann
 
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Wow, Judith! Your message is exactly what I was hoping to hear. Thank you so much! As of right now, I'm not quite sure now if I am going to get the surgery. I don't feel like I have enough info about it, and feel wary about changing my anatomical structure (again). I'm going to contact the Cleveland clinic. Then I also ask myself at what point is enough enough? I might just ride these buggers out as long as I can and if I end up with an ostomy, I feel lucky to have been Ble to have a jpouch for so long (5 years so far!).

Thanks again!!!!
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