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[earthshine]

Hi,
I started having diarrhea on/off while visiting india two years ago.

Was diagnosed with Candida/yeast overgrowth last year

this year, while doing a strong antifungal program, i had some constipation, and ended up shortly later with an abscess.

Now, I was diagnosed with a fistula .

I am in process of going through GI testing.

I need to make a decision, regarding how to move forward with the fistula, and am open to input from those who may have more experience.

I have two opinions
1) the first surgeon, recommends LIFT procedure. the fistula starts in the anus, comes down about 8 inches. it has a branch towards the bottom halff. the Doctor said he would put in a seton, which would shorten the fistula. he would put in a stitch towards the anus, and clean out the remainder of the fistula, hoping it will collapse and heal. the fistula would drain from near the stitch near the anus. he has not expressed any concern with respect to any ibd issues i have

2) the second surgeon, recommends putting in a normal seton (through the entire loop). then waiting to see what GI recommends (appt in one month). and perhaps putting in a plug. she does not want to do any surgery without more input from GI.

Any thoughts? not sure why two diverse opinions...

i like the idea of having a shorter fistula, in the first option. but also appreciate the second doctor taking it slow, and really seems to be taking in the entire picture.

A

 

[Deanne]

Hi Earthshine, sorry to hear you are going through this, it is a painful and messy situation.
I got a fistula about three years ago and it was right near my anus. It actually went throw my sphincter muscle so my surgeon put in a looped seton. It drained perfectly over the course of a year. Every six weeks I would go back and he would tighten the seton, this was so it slowly cut its way throw the muscle. My surgeon told me if he didn't do it this way I could have lost the use of my sphincter. If was a little painful when he tightened it but I am happy it say it healed perfectly.
Hang in there, what ever way you choose to go is going to be a pain in the bum (pun intended). Sometimes the shortest option is not the best for size and placement of your fistula.
Good Luck.

 

[earthshine]

Thanks so much for the response.

Is this considered a "loose/draining seton,or a "cutting seton"? Or another type?

I would love to be able to have mine heal in this way.

I am not sure why my doctor indicated it would not heal with the seton in... ?

Mine also goes through the muscles.

Any ideas?

 

[Deanne]

I am not sure what the correct name for it is, but my surgeon explained it this way. He told me to think of my sphincter muscle as a rubber band and my fistula as a small hole in the centre, if he put in a normal seton and it didn't work the whole could get bigger and the band could snap and I would loose all control of the muscle that stops the poo coming out. By inserting a looped seton and making it cut through the sphincter muscle slowly, it forms scar tissue as it goes and will heal over correctly.
I am not sure why your doctor says it wouldn't heal this way, it is a very long and sometimes painful process but for me, it was all about still having the function of my muscle.
I was diagnosed with Crohns at the same time and was put on a heavy dose of medication which may have also helped. If you are unsure of which option to take, you should definitely get a second option.

 

[earthshine]

Thank you Deanne. I understand medications can help too. Are you still on the medications now? I wondered if the fistula stays closed, regardless if one is continuing with medication.

 

[Deanne]

I am now in remission but I still take a maintenance dosage of my Pentesa medication. I have and always will take this medication because if I don't I run the risk of this horrible disease showing up again. Some people go off their medication successfully but I am still kind of new (almost 4 years) to Crohns and am to scared to go off it. My GI said we will discuss it next appointment, but I'm feeling great and don't want to ruin it.
My fistula has stayed closed and other an a couple of issues around "that time of month" it's all good.

 

[earthshine]

Deanne, were you on Pentesa when your fistula healed?

 

[Deanne]

Yes I have been on pentesa from the day after I was diagnosed.