Getting rid of fistulas

[Sascot]

At the risk of sounding like I'm clueless, I truly do not understand why surgeons do not do surgery to get rid of fistulas.
I do have a fair amount of random medical knowledge through growing up with a GP for a mother, and yet I am still struggling to see why they cannot just close it up?
When I spoke to the surgeon he said the channel of the fistula was like healed skin which made it hard to close up with stiches as the sides would not "stick together", so I am confused as to how medication is supposed to miraculously close up the fistula.
I read the post on VAAFT and it seems like a really good idea. If you go into the fistula, give it a good clean, scrape away some of the lining of the fistula channel and then stitch or glue the area together, then surely there is more chance of the skin knitting together and closing the fistula for good. I don't get the setons that just sit there and let it drain for what seems like years for alot of people.
If you did the surgery and give the medication then it seems logical that the surgery would help close the fistula and the medication would help bring any inflammation under control so that it has a better chance of healing right.
I understand that alot of fistulas are complex and harder to deal with, but for those with a fairly straight one that is quite small, this should be easy to do.
Sorry for this long rant, I don't like the thought of my son leaking stuff out of his bottom for years while he has to go to high school when it seems fixable to me.

 

[Sailorluna]

They can do surgery to get rid of the fistula its called a fistulotomy I think. The issue is they won't do it for people with Crohns. I believe it is an problem with us not healing correctly ofter the surgery. I think the key is getting the disease under control which will allow it to heal into a "tube" that can drain anything it needs to without worry of backing up and causing an abscess. When that happens they can remove the seton.

For me, when the inflammation is under control the drainage slows dramatically.

Fistulas suck. I hope you find the answers you are looking for.

 

[PsychoJane]

Hum... I know perianal involvement is quite complex. I think that a part of the reason they are not prone to do fistula surgery is the risks of complications and incontinence issues.

http://emedicine.medscape.com/article/1582312-overview#a01

That link is interesting in understanding the fistula anatomy and so on, but unfortunately, all it says about fistula and crohn is that it is contraindicated but they do not specify the whys. I'm gonna try to find out. I think they did a fistulotomy with my peristomial fistula cause I'm trying to figure how they could have done a complete fistulectomy with them... Now I'm quite wondering what they did as I type that... lol. Anyway that makes me believe there might be something related to the localization of the fistulae to justify the why they don't get ride of them surgically. Like, bowel to bowel fistula are likely to be removed, same goes with bowel to organs.

Ok, update (I'm searching my reference at the same time I am writing this), the incontinence risk is really what motivates them to not rely so often on fistulotomy, 35-59% (5-15% of severe incontinence)[Pigot F. (2003)- Fistules anales et colles biologiques].

Here's another interesting pdf for those who might be interested, I like the illustrations:
http://www.mssurg.net/Team5Conferences/2005-6/Anal%20Abscess%20and%20Fistula.pdf

Also, it seems to be related to the type of fistula and fistula location. Some seems to be appropriate for fistulotomy while other, that goes across sphincter seems to be problematic when it comes to praticing that type of surgery. Also, it seems there is a considerable risk of relapse and eventual need of proctocolectomy.

http://www.ncbi.nlm.nih.gov/pubmed/2022142

This disease sure is a complex beast...

 

[GutlessWonder86]

I had surgery done to get rid of a fistula back in 1988. It got so bad that even flagyl didn't help and I had fecal output coming out of my abdomen. So the surgeon moved my ileostomy to the other side, cleaned out the infection and got rid of the fistula. haven't had any problems since.

 

[claire d]

I have a 12 year old boy who has had a fistula 'laid open', so doctors talk about it as though it has gone, but he has had an open wound (perianal) for months, plus fissures. Apart from leaking, the pain and spasms are often excruciating, causing him to shriek every few seconds for hours or days. Painkillers do not help much, if at all. We are waiting for biopsy results, but this is the 3rd investigation where no signs of IBD have been found. So no other medication prescribed, except for antibiotics. Like many other parents have said, it is awful not being able to help your child. And I just don't know what the next step is.

 

[brooke206]

At the risk of sounding like I'm clueless, I truly do not understand why surgeons do not do surgery to get rid of fistulas.
I do have a fair amount of random medical knowledge through growing up with a GP for a mother, and yet I am still struggling to see why they cannot just close it up?
When I spoke to the surgeon he said the channel of the fistula was like healed skin which made it hard to close up with stiches as the sides would not "stick together", so I am confused as to how medication is supposed to miraculously close up the fistula.
I read the post on VAAFT and it seems like a really good idea. If you go into the fistula, give it a good clean, scrape away some of the lining of the fistula channel and then stitch or glue the area together, then surely there is more chance of the skin knitting together and closing the fistula for good. I don't get the setons that just sit there and let it drain for what seems like years for alot of people.
If you did the surgery and give the medication then it seems logical that the surgery would help close the fistula and the medication would help bring any inflammation under control so that it has a better chance of healing right.
I understand that alot of fistulas are complex and harder to deal with, but for those with a fairly straight one that is quite small, this should be easy to do.
Sorry for this long rant, I don't like the thought of my son leaking stuff out of his bottom for years while he has to go to high school when it seems fixable to me.

HI get another surgeon Ihad abdominal fistulas which discharged for almost 7years after a re-section, my consultant was unwilling to operate so I got my Gp to refer me to a surgeon who specialised in gastro surgery that was Nov 2011 I healed very well and have had no problems since I am however aware that threre is a chance the fistulas can re-occur but keepimg my fingers crossed so far so goodt keep trying especially for some-one so young he needs hope

 

[ontariomom]

I hve two peri rectal fistuals one is complex and they dont want to do surgery as it would involve cutting too many of those muscles...which leads to incontinence. So i have a drain in one side, been there for just over a year. And the other side is just as it is. I ache on days when i have alot of D, and i weep as well those days. I find that painkillers help a little, but not greatly. The best help is sitz baths and sitting on heat.

I dont always understand the whole why they wont do surgery thing either. I know in my case as they explained they dont want to cut those muscles and i do appreciate that. But on the other hand it would be nice not to ahve a sore butt .

Clair d...the spasms are horrible. I havent had any for a while now but i was having them non stop for months. And honestly lots of heat is my only advice. I cannot imagine a child feeling like i feel. It breaks my heart. I use T3 for pain as that is all my GP will give me. And they dont help much at all. they do take the edge off. But that is it. Unfortuneately, before i knew people with CD should not take it, Motrin worked better then most things for that sort of pain. I do miss motrin.......

 

[Monika Anna]

Hi,Monika had 3 enterocutaneous fistulas develop following surgery, the wound was vacuum dressed to allow further drainage for some months but the wound eventually closed leaving these fistulae still draining, although still mostly nil by mouth and on TPN, output was moderate. These issues as far as we know ourselves and what we have been told were a byproduct of surgery (6x in 4 months).

Although once home Cipro would be prescribed periodically and would take usually a couple of days and the output was reduced to nil and would last for around 2 weeks while on the medication, but also within 2-3 days output would resume again slowly, and that was where we were at up until 5 weeks ago.
Take care Monika & Matt.