Jenners, this is a tricky enough question that you might want to get a second opinion. I’m skeptical that your “alternate stuff” actually worked wonders, but the inflammatory problems can certainly fluctuate over time, sometimes getting better, and sometimes getting worse. In particular I think a second opinion could help with the surprising advice not to treat this medically, in fear of healing your currently-helpful fistula. If fistulas healed so easily we’d have a lot fewer people posting here. The surgical path forward is also complicated. I hope you can find an approach that you’re comfortable with and that works well for you.