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Crohn's Disease Forum » Surgery » Fistulas, Fissures and Abscesses » Abscess recovery so slow - next op....the fistula



07-01-2014, 01:09 PM   #1
Sazzle
 
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Abscess recovery so slow - next op....the fistula

Hi all,
I had my perennial abscess removed 2 weeks ago, I'm still having it packed and dressed daily, it's recovering very very slowly... The hole is still like an open canyon! I stupidly got the nurse to take a photo when changing the packing and dressing - I wish she hadn't.

The fistula they want to operate on next ( they aren't sure if the fistula came first in my case) is a transsphincteric fistula.

I'm having a meeting with my consultant on the 24th a July, but today I had an appointment with my doctor..... I asked him about operation options etc...

I was so shocked when he explained that because my fistula goes through the inner and outer sphincter muscle it's a little more complex - as cutting sections of the muscle may lead me to being bowel incontinent - so sometimes surgeons prefer to shut off the fistula and fit the patient with a stoma bag.... This could be best for me, or the surgeon may operate but still no guarantee that I won't have bowel incontinence.

Has anyone had a fistula removed where they have also removed part if the sphincter muscle?

Thanks in advance
Sazzle xx
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Perennial Abscess diagnosed April 2014
MRI in June 2014 - Transphincteric Fistula aswell as the Abscess.
June 18th 2014 - Abscess removed under general anaesthetic .Wound packed and dressed daily for 8 weeks.
September 18th 2014 - Fistula "laid open" under general anaesthetic - wound packed and dressed daily for 6 weeks.
November 16th 2014 - As above.
April 28th 2015 - Seton placed under general anaesthetic . Leaking everything at present. Itchy. Sore.

Last edited by Sazzle; 07-01-2014 at 06:09 PM.
07-01-2014, 05:37 PM   #2
Suehelb
 
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Best of luck! Dealing with fistula myself. They want to put a seton in to help but am nervous. I have never gone in and had it packed each day? That is interesting. I don't think you can cut through the sphincter... My Doct says he can't give me a new one if those. 😁. Best of luck!
07-01-2014, 06:08 PM   #3
Sazzle
 
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Hi Sue
It's the abscess cavity I'm having packed each day (The "hole" is 60mm x 30mm and 50mm deep.)
They have to pack it so the wound heals from the inside.... Sadly will have if daily for another 2 weeks ( 4 in total) then drop down to every other day and so on.... Once it's healed I can have the fistula surgery.

Apparently they can cut through the sphincter - but it's a lot of risks, so that is why sometimes they prefer to just make a bypass.

If your fistula isn't going through your sphincter , apparently there's a lot more easier options.

I'm hoping to find someone who has had a transsphincteric fistula for advice!

Good luck with yours Sue.

XX
07-01-2014, 06:15 PM   #4
Jay Woodman
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[QUOTE=Sazzle;793237]Hi Sue
It's the abscess cavity I'm having packed each day (The "hole" is 60mm x 30mm and 50mm deep.)
They have to pack it so the wound heals from the inside.... Sadly will have if daily for another 2 weeks ( 4 in total) then drop down to every other day and so on.... Once it's healed I can have the fistula surgery.

Apparently they can cut through the sphincter - but it's a lot of risks, so that is why sometimes they prefer to just make a bypass.

If your fistula isn't going through your sphincter , apparently there's a lot more easier options.

I'm hoping to find someone who has had a transsphincteric fistula for advice!

Good luck with yours Sue

I have a transphincteric fistula & have a seton placed.
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07-01-2014, 09:24 PM   #5
Suehelb
 
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You have a seton now? That's what they would like to do for me but I'm very apprehensive. Is it painful, how do I function afterward, can I go to work, recovery timeline, etc... Would love to hear more about yours?

I can only imagine how hard it is for you to have yours packed everyday. Hoping it is under light sedation? This disease can present its challenge. Praying for fast healing for us both!
07-02-2014, 12:21 AM   #6
Sazzle
 
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Hi Jay
I hope you don't mind me asking, but have you lost any control? I've heard of a seton, but to be honest this is all so new to me - does this mean you still have the fistula rather than have it removed?
XX thankyou
07-08-2014, 03:53 PM   #7
justbreathe8
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My fistulas did not go through the muscle, so Im not sure about that. Not to hijack this post, but just wanted to answer the questions about setons…when you get a seton, its like a string so to speak, that goes in your anus, through the fistula, and out another hole that the surgeon makes, right next to your anus. This keeps the fistula open, and keeps it draining, which keeps it from getting reinfected. Once the area is calmed down, they sometimes take them out to either close on their own or have surgery to close the internal opening of the fistula. I had 3 setons for the past 9 months, and just had the surgery last tuesday to get them all taken out. But when they were in and the area had finally calmed down, you are able to do everything you did before, mostly pain free. You can workout, swim, run, jump, ride a bike, have sex, whatever you normal do. It was just a hassle to keep the area clean and keep doing sitz baths, but it was the only option.
07-08-2014, 07:57 PM   #8
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I have fistulas and abscess and also a seton and a colostomy. Also I have had multiple surgerys and Remicade. Imuran and antobiotics. Sometimes the abscess and fistula tracts heal sometimes they dont. When I haf fistula 8 years ago i had two setons placed and Remicade and the fistulas healed and the took out the setons. This time nothing seems te stop the infection. But dont worry because you can live a good life with setons. You need to get the infection out and have proper drainage. I wish you good luck!
07-08-2014, 08:11 PM   #9
Jay Woodman
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Hi Jay
I hope you don't mind me asking, but have you lost any control? I've heard of a seton, but to be honest this is all so new to me - does this mean you still have the fistula rather than have it removed?
XX thankyou
I currently have two double tract fistulas which each required two setons. Yes, with setons in place this means that I still have fistulas present. As long as I have setons in place this will allow drainage of the fistula, prevent an abscess from recurring and avoid the risk of possible incontinence that a fistulotomy of a transphincteric fistula may cause. In my case, and as far as I understand, draining setons actually avoid placing the patient at risk of incontinence. Whereas, surgical intervention with a fistulotomy may carry a risk of incontinence but this is of course dependent upon the location of the fistula. I hope this sheds some light on your query. Please feel free to ask questions : )
07-08-2014, 08:30 PM   #10
Jay Woodman
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Hi Jay
I hope you don't mind me asking, but have you lost any control? I've heard of a seton, but to be honest this is all so new to me - does this mean you still have the fistula rather than have it removed?
XX thankyou
Sazzle, I think you would find it helpful if you started to read some reference material on perianal abscesses & fistulas. Here's a simple reference you should find helpful. I have lots more if you would like me to share.

http://www.fascrs.org/patients/condi...scess_fistula/
07-09-2014, 10:34 AM   #11
Sazzle
 
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Thankyou all so much xx
.....and please feel free to share Jay, it's a great help, thanks xx
09-02-2014, 06:45 PM   #12
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Ok....... So the abscess was removed - was huge - fistula (s) op due on the 18th September.....

For the last couple of weeks I've noticed some spotting/leakage - I thought it was from my scar tissue, however tonight I've discovered a big red spot on the other butt cheek in exactly the same place as my scar tissue...... Could this be the start of something new?

XX
09-03-2014, 03:30 AM   #13
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I am so sorry about that! See your dokter asap!
09-05-2014, 01:02 PM   #14
Sazzle
 
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Well I had my pre-op assessment today....I mentioned that a "big spot" had appeared on my other bum cheek - she had a peek, and yes it's a sign of another fistula....I was a little shocked as the previous abscess was huge whereas this just looks like a huge spot/small boil, well at present it does.

But as she was just a general nurse that's all she could say - it's been added to my notes for the day of my op....

No idea if this is continuation of the "already there" fistula which could mean it's a horseshoe..... Or a seperate one....

Feeling nervous xx
09-19-2014, 10:11 AM   #15
Sazzle
 
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Hi all
I had my fistula "laid open" yesterday - was a little upset that I didn't even get to see the doctor before I was discharged - so other than knowing it was "laid open" I really don't know much all.

The wound is nowhere as big as the abscess wound - this knew is only about and inch and a half long and 2 inches deep, so hopefully recovery will be quicker!

The great news is that they do not think that's another fistula on the other side, they are going to keep an eye on it but they think it may just be a coincidental bad spot! I hope they are right...

My discharge letter will be here in a few days although they rarely say much - I go back in 4 weeks to see the surgeon so I guess I will know more then ...

It's an endless battle isn't it?

XX
09-19-2014, 11:58 AM   #16
Jay Woodman
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@Sazzle Wondering how you were doing : ) I had my third fistula procedure yesterday as well. The surgeon placed another silastic seton in this fistula which unfortunately was also a double tract like the other two previous fistulas. Recovery also slow on the second day : )
09-19-2014, 04:04 PM   #17
Sazzle
 
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Hope your recovery goes well Jay xx

I felt horrendous after the general aenesetic this time, yet last time it didn't bother me - it's all odd isn't it, how different we can be each time? Still it's over for now.

They discussed with me beforehand that they were hoping to put a seton in, but due to it being transsphincteric they weren't sure until I was under examination whether it was too high....... Well they didn't put one in so I'm guessing it was too high.....

I went in as a day surgery patient so I didn't see the doctor before I left, which seemed odd - but I guess I will discover more in my discharge letter or follow up appointment.

XX
09-19-2014, 06:12 PM   #18
Jay Woodman
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@Sazzle... Interesting I had a different Anesthesist this time & for the first time my throat was very sore & initially when I woke up was dizzy & shivering. Like any Dr. I guess each Anesthesist has their own approach!
09-20-2014, 02:50 AM   #19
Sazzle
 
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True Jay - shall we both ask for the previous one next time!!? ;-) x
09-20-2014, 11:34 AM   #20
Jay Woodman
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True Jay - shall we both ask for the previous one next time!!? ;-) x
Funny..I was thinking about doing just that when she introduced herself.. My brain was saying...."Hey where's my regular Anesthesist?" But I didn't let my mouth communicate that...LOL
09-20-2014, 01:56 PM   #21
Sazzle
 
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Lol.....I'm going to be so tempted if I get this one again! XX
10-30-2014, 07:44 AM   #22
MikeinBklyn
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I had two lay open abscess / fistula tract surgeries. They are very slow to heal and must heal from the "bottom up". I did not have any sphincter removed.

I had my wife (saint) take a photo every day so I could witness the healing. It made me feel better, her not so much

Best of Luck.....and take as many warm baths with epsom salts as you can!
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10-30-2014, 02:24 PM   #23
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I'm two weeks out from an abcsess draining/seton placement. Overall it was my third in the past 8 years. This one seems to be draining a lot more, and the pain sucks. I'm out of oxycodone, which made everything tolerable and gave me wonderful bowel movements.

I hate changing underwear twice a day, after my pads, gauze, liners get saturated.
10-30-2014, 03:21 PM   #24
Sazzle
 
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Sooooooo...... I was re-opened last Friday as the entrance to the cavity had closed, whilst the cavity was still over an inch deep.
It's been 5 weeks since the fistula was laid open and I've still having it packed and dressed daily.
Although I must admit, I'm not finding the fistula draining as painful and messy as the huge abscess I had....

Because they didn't remove the fistula fully ( because it's going through my sphincter muscle ) who knows what the future holds.
XX
11-26-2014, 03:39 AM   #25
Sazzle
 
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Totally fed up......

The fistula wound packing stopped 2 weeks ago ( after 7 weeks of being packed and dressed ) - other than a little itching from the scar I've had 2 weeks of "being normal"
Alas...... For the last 2 days, I've had pain in my lower butt cheek and the scar has been leaking a fair amount of yellows puss ( enough for me to have to wear a dressing over it...

Is this usual? Could it be a sign that it needs re opening again?

Xx
11-26-2014, 02:20 PM   #26
Sailorluna
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no seton? It is a fistula right? Are you still doing baths to pull any ick out?
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11-26-2014, 06:22 PM   #27
Sazzle
 
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Yes it "is/was" a fistula - a Transphincteric fistula that was removed as far as they could to the sphincter muscle, but the fistula was too high through the muscle to remove the part that was going through it - so a risk of reaccurance ( but I didn't think it would be this soon! )
The wound was packed and drained daily for 7 weeks until it healed, there was no seton placement.
A few months before this I had a very large abscess removed.

I'm bathing as normal now - was told to just carry on life as normal as its all healed ....but.....

XX
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