Any experiences with seton removal with no fistula surgery?

[ginakra]

Hi all. Had my first experience with an anal abscess and fistula in July. Didn't know it wasn't a hemmoroid, which my pcp diagnosed, until late September when I saw the colorectal surgeon. I had a seton placed on Oct 8. I've been pretty miserable. It hurts all the time. I have severe allergies, and have reacted to a lot of stuff that supposed to help like creams and otc painkillers. My CRS mentioned surgeries to close my fistula, which runs from rectal/anal to about an inch to left of anus. At least that is where seton is entering/exiting. It was tunneling to vaginal wall. I also have some around the sphincter apparently.

My question is, has anyone just had their draining seton(s) removed without having any further surgery to close it up. I have been given this option along with advancement flap and lift procedure. I'm honestly kind of done with all this. I'm worried about not closing the fistula and the abscess reappearing, but I'm not sure chances are any better than having the procedures done.

Did your fistula close and heal after a simple seton removal? Experiences please. Thank you.

 

[Robrich]

It won't heal if you remove the seton while it is still active.
You need to get the activity quieted down, perhaps with antibiotics and then have no drainage for awhile before removing the seton.
If you don't have Crohns fistulotomy surgery is probably your best bet.
Check out threads here regarding that as there are some posters who have had great success with certain types of surgeries.

 

[lgpcarter]

My fistulas closed with just the seton. Had it removed around 7 months after placement.

You still have pain, inflammation, drainage? If so, they likely need to stay in longer.

 

[Robrich]

Igpcarter
When you had the Seton in you were not taking any crohns meds?

 

[ginakra]

I have not been diagnosed with Crohns or other digestive illness..yet. I had been having diarrheah for a couple months from what I thought was stress but the abscess came so fast and furious I did not have time for any gastro doctor to look at me. I have had bouts here and there with issues and my doc thought I might have ibs. I go long periods where I'm just fine though.

 

[ginakra]

I have not been diagnosed with Crohns or other digestive illness..yet. I had been having diarrheah for a couple months from what I thought was stress but the abscess came so fast and furious I did not have time for any gastro doctor to look at me. I have had bouts here and there with issues and my doc thought I might have ibs. I go long periods where I'm just fine though.

I came here because 8 could not find any other forums or places where anal abscess and fistulas were discussed, and my CRS Said it might be first sign of Crohns or other problem.

 

[ginakra]

It won't heal if you remove the seton while it is still active.
You need to get the activity quieted down, perhaps with antibiotics and then have no drainage for awhile before removing the seton.
If you don't have Crohns fistulotomy surgery is probably your best bet.
Check out threads here regarding that as there are some posters who have had great success with certain types of surgeries.

I have had very little drainage for about three weeks. It's not totally dry though. My CRS Said a week ago that he likes to see them a bit drier, and to see him in two weeks we might take it out, and explained the other options only briefly. He's kind of vague.

 

[ginakra]

My fistulas closed with just the seton. Had it removed around 7 months after placement.

You still have pain, inflammation, drainage? If so, they likely need to stay in longer.

I have pain but I can't tell if it's from just the seton being there and the irritation of some of the drainage. I can't see the drainage usually. It seems clear in "color". Every once in awhile I get a little creamy yellow stuff from the inside buttock exit point of seton. Usually after a bowel movement and it stops pretty quickly.

 

[Robrich]

Ginakra it doesn't sound too bad. If you are not taking any meds and the drainage is minimal and there is no indication of internal abscessng, I would go with your CRS' recommendations. Although I would strongly suggest antibiotics before and after removal as a precaution.
BTW read through the fistulas fissures and abscess support thread or do a search for related posts and threads. You will find posts form others with similar experiences esp. Non Crohns diagnosed fistulas.
I think diarrhea can cause fistulas if you have a sore or fissure that can easily become infected.

 

[lgpcarter]

That sounds pretty good. Might be worth trying removal. I didn't think mine were ready to come out when the surgeon said they were. He was right!

 

[ginakra]

That sounds pretty good. Might be worth trying removal. I didn't think mine were ready to come out when the surgeon said they were. He was right!

Why did you not have surgery to close the fistula, lgpcarter? I made another thread for this question, but how long did it take for the fistula to close after taking the seton out?

 

[Robrich]

Ginakra fistula surgery doesn't work for Crohns patients. Treating fistulas is very different for Crohns and non Crohns patients.
Crohns patients need meds to control the inflammation and intestinal damage which is what caused the fistula.
I take it you do not have Crohns so in your case surgery, flap or whatever often works.

 

[ginakra]

Ginakra fistula surgery doesn't work for Crohns patients. Treating fistulas is very different for Crohns and non Crohns patients.
Crohns patients need meds to control the inflammation and intestinal damage which is what caused the fistula.
I take it you do not have Crohns so in your case surgery, flap or whatever often works.

Robrich, thanks. I'm not diagnosed with Crohns, no. I'm very confused and frightened. I'm having a hard time finding any information that applies to me. What i'd like to do is just to remove the seton and not have a surgery. I'm just trying to find experiences but I can't. My CRS says it's a good option "due to my circumstances" which is loads of allergies, not having good experiences with surgery, and being unable take very many otc drugs or treatments, etc. I'm trying to find out if this is a really bad idea though. I'm afraid of incontinence, as I'm doing well enough in that department that I don't want to make it worse. I guess I'm a worrywart.

 

[Robrich]

Most of the stories I have read here for non Crohns fistulas have had surgery of various sorts.
These things are very stubborn. I think some have had success with diet or even an elemental diet for a short time.
From what you've said if there is very little drainage and no abscessing internally (might show in high WBC) and your CRS Is good with it then take it out and see. While not fun you could always have it put back in and go for surgery later.
I highly recommend the antibiotics Flagyl and Cipro or augmentin for 2-4 weeks before and after removal.
Good luck