Should a Seton be placed in to drain fistula before sugery?

The seton could be placed while you're under sedation. I'm concerned that you might be overconfident that surgery will cure this fistula. Fistula surgery seems to have very mixed results. Many folks here choose to live with a seton for years rather than accept the risks of failure or complications that seem to be part of many surgeries. Can you have a frank conversation with your surgeon about what's reasonable to expect?

Yes, setons are typically  first placed during an EUA.  I can only imagine that the doctor's attempt was painful for you.

My CRS told me she would not attempt any surgery until a seton was placed and the tract skin given a chance to heal.  Me being me, however, that healing still hasn't happened nearly 5 years later, although the discharge has very much decreased and the seton is quite manageable.   I am one of those who chose to live with the seton as my surgeon (and I) did not have high hopes on any type of repair attempt, due to the specifics of my fistula.  As Scott suggested, do speak with your surgeon for surgery specifics/possible outcomes, etc.  before scheduling anything.

Yes, hot water baths can help keep the opening open, but like everything else we experience, there are no guarantees.  Do it as often as you can - 2, 3+ times/day.   I recommend a toilet sitz bath - https://www.amazon.com/LifeStr...ds=family+life+straw for the convenience. 

Best of luck with all this!

hi Scott and my anonymous friend,   thank you for your advise.

My doctor insisted on doing surgery.  He is not too happy that I did not come to schedule surgery since I first time visited his office 1 year ago. But he also said if he opens it, he may find he could not cut the sphincter muscle, and he will put a different kind of seton there. I don't know what will happen afterwards.

I had a seton back in August (which I asked the doctor to put on) and then I went on a month long travel and felt very uncomfortable, and cut it off myself because the doctor did not say I should leave it for how long. How could the seton be left there for years? The seton was pretty stiff and it really irritated a lot when I sit or doing something. I wish I had not cut it off though.

I am just using a basin to do the bath. Will the opening be infected by that? Is the purpose to get the opening wet?

thanks again,

Jim

Soaking actually prevents infection, rather than causing it. It is already considered a "dirty" wound, so sterility isnot needed. Soaking prevents the opening from healing over prematurely, so that the fistula and abscess that was drained can continue to drain.

Jan

Hi. My son has had serious issues with fistulias and abscess. His however have been internal. I dont remember what a seton is but what has been done for Jeff is this. An external drain to get the yuck out. It helped but not a cure. Lots of pain for the last 6 months ir so. In Sept they did something that may be considered expermental. They created a biological plug that was inserted through the drain into the abscess, through the fistulia and into his small intestine to close up the leak. He isbeing treated at a major medical center in NYC. So expermental us what they live for its been six weeks now and , i hate to say yet, successful. The folks here who know my son's story know what he has been through oh they also removed the drain. What he has now is all internal. Im not sure what they are trying to do tp you with surgery. I guess it depends where the fistula is located. But jeff's proceedure may be another option for you. Good luck!

hi Jan, 

Your theory is some relief for me However after soaking, I feel more pain a few hours later. Maybe that's because I just had incision yesterday.

All the best!

Jim

Jeffsmom,

What you have been through must be terrible. I cannot imagine my children have this kind of problem since such a young age. I've seen some website on internet mentioned that kind of bio-plug. Wish the experiment will be successful and your son feels better thereafter.

Jim

I will caution you against them doing the typical "lay-open" procedure.  I had a pouch and that is the procedure the surgeon did on me for my anal fistula, and it left me with damaged sphincter muscles and incontinence.  I had a sphincter repair surgery after that, which helped some, but still left me functionally incontinent.  I have learned ways to live with this, but I sure wish they had offered me a drain or other more conservative options or communicated to me in any way that my incontinence could be compromised, as I doubt I would have agreed to the surgery as quickly as I did.  During the consult I kept saying "I don't want anything to happen to the pouch", which nothing did happen to the pouch, directly, but what happened to the sphincter left the pouch unable to perform as designed (continent).  Best of luck to you-