From all I've read and been told, the type of fix depends on where the fistula starts in the rectum. Fistulectomies are successful because they cut the whole thing open. Longer healing process, but the fistula is gone. If the fistula starts too high up in the rectum, a fistulectomy would cut through too much sphincter muscle and leave you immediately incontenent (this would be me)
My doc says fistula plugs have a 30-40% success rate in CD but they are non-invasive and you can try repeatedly (if you have the money and don't mind risking abscesses!). My doc says my option is the advancement flap procedure, where they cut a flap of tissue , fold it over the fistula hole, and sew it closed. Works really well in non-CD but only 70-80% in CD (our tissue just isn't normal and doesn't heal well). At this point in my life, I don't like the odds, so I will keep my nice. friendly setons. They really work even though they do have challenges (like keeping them clean -- a much discussed topic in previous posts). The advancement flap is an option I may take in the future.
Also, there isn't any prep for a seton placement. It is all done in the OR. If they ask you to use an enema beforehand -- DON'T! I did and the liquid just shot out of the fistula and burned like crazy! They clean out the rectum while you are out anyway, so you don't have to do anything except show up. They use thin wires to trace fistula tracks, and dyes and imaging too -- but you will be out cold so who cares!
Hope this helps!
Post Edited (NY-Sooner) : 3/25/2015 10:48:36 AM (GMT-6)