Fistula treatment

[Bill41]

While I was at the hospital the surgeon was the first one that saw and examined me and found the 3 fistulas, I had done some research about treatment on the web beforehand so I asked him about the various methods used, fibron glue, skin flap and he said the only thing that works is a draining seton. Non of the other treatments worked.
Anyone have any info about that? Is he correct or just setting up for future patient work?

 

[beth]

Setons work, you need to keep the tract open to drain the tract and any internal 'branches' else it blocks and you get an abscess form and pain. Seton's aren't great however, by keeping the tract open you leak puss and blood. Sometimes a lot, sometimes little, wearing a pad in your undies 24/7 is a real nuisance.

Once the tract has healed and there is little leakage, and the internal opening part of the tract is narrow, things like fibrin glue can work - my surgeon was very surprised that mine worked. The success rate is poor but there isn't anything any better. Skin flaps/etc have similarly poor success rates.

 

[Mark63]

Hi,

Other treatments do work, but as Beth has said, the success rate tends to be poor. In addition to those you have already mentioned you could add the fistula plug, but my Surgeons have quoted 30/40% success at best in Crohn's patients.

Sometimes the fistula is laid open and just allowed to heal, but this is not a good option if a significant portion of the sphincter muscle is involved.

The best bet seems to be a combination of draining setons and drugs such as Remicade.

If I find the answer I'll let you know, but I've been looking six years so far. Sometimes, this is something that you just have to live with.

Mark

 

[Bill41]

Thanks, I wasn't sure I was getting the full story from the surgeon...he did say the remicade will heal them up so surgery may not be necessary...
You would think something like that could be repaired easily with todays technology, such as scraping the channel with a flexible pull through type instrument and then sewing or sealing it shut after disinfecting.

 

[beth]

I think they have tried many different treatments over the years, but fistulea aren't usually so straight forward. My surgeon said they often have internal branches (much like a tree) that wend their merry way into your flesh/muscles/etc and these have to drain, as well as the main tract.

The biologics do seem to keep them at bay or help to close them, so if you can get on one of them....

 

[Bill41]

Thanks Beth...sure looks like I'll be going either Humira or Remicade.

 

[exit4]

Please try non surgical options firs, DO not go for "lay open" - I had it done and it did not heal correct - I am now leaking after BM. MY docs - both GI and surgen never mention Humira or Remicade as an option at all!!!Now I know better, but it's too late.