Fistulectomy and Cutting Seton

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DJL81
New Member


Date Joined Dec 2011
Total Posts : 12
   Posted 12/5/2011 9:22 AM (GMT -6)   
Hi All
 
I have read, with much interest, the various threads regarding the above treatments and thought it would be helpful for me to share my story with you;  I understand how helpful these forums are for people who are undergoing or have undergone such a procedure.
 
In short: eights years ago, I had a fistula which was laid open ("fistulectomy) and it healed fine and I had eight years of no pain or problems.
 
In September 2011, I noticed that I had an abscess and asked my doctor to refer me to a colorectal surgeon - these are the only surgeons who you should go to.  At first, my doctor didn't want to refer me to a specialist but I insisted based upon my own experience and because I had private medical healthcare and the option was there.
 
My surgeon met with me and said that it looked like I had fistula but that the only way to make sure was to have an MRI scan.  I had the scan and it confirmed that I had two fistuals (one branching off from the other).
 
My surgeon explained that part of the fistula could be laid open and that the other part needed a seton stitch.  As others have said on this forum, he explained it to me by way of a hot needle slowly passing through an ice cube.  The ice cube freezes over and scar tissue forms where it has healed thus hopefully removing the risk of incontinence that is attached to a scalpal cut.
 
You should note that a "cutting" seton stitch is there for two reasons: allow the infection that is "feeding" the fistula to drain; cut through the fistula so that it can heal on its own.
 
I went for the surgery and had a general anaesthetic.  When I came round, I was not in much pain because the anaesthetic was still in my system.  I was discharged on the same day after I had eaten something and urinated.
 
On inspection, I had a dressing over where the fistulectomy and a rubber band coming from my anus and just outside of the fistulectomy.
 
I admit on the first day, I did experience a lot of pain because the fistulectomy was new.  It was not unbearable and I lay on my side to ease the pressue.  I think my fistulectomy was superficial because it only took about two weeks to heal (packing with Aquacel every day).  Aquacel looks like gauze but then turns into a jelly that promotes healing by capturing the excudate (puss) and blood and also trapping microbes within it.  Must admit for the first few days, your wound will smell a bit but this does subside.
 
As I said, the fistulectomy healed ok although I did get some "overgranulation" which was treated by applying 1% hydrocortisone cream once a day and a lyofoam dressing.  These were all available on an NHS prescription.  The overgranulation healed after a week of it ebing noticed by the District Nurse (for the benefit of US readers, a DN is a dressings nurse here in the UK).
 
After surgery my seton was slightly painful but I think this was more the fistulectomy.  It felt like somebody was pulling down and it was uncomfortable but not like a sharp stinging pain that was associated with the fistulectomy.
 
I admit it was weird but I could not feel it cutting, I only felt  a new pressure on my sphincter. 
 
I took Lactulase twice a day to keep bowel motions soft and also used Fybogel to help me go.  Surgery "down there" can shock your body and you may be reluctant to go.
 
BM are not as painful as you may think if you use the lactulase and fybogel.
 
My seton has not been tightened regularly and I am going for my first and last tightening a month after the seton was placed.  my surgeon explained that he will put me under a GA, tighten it and I can then go home.  He said it will be uncomfortable for a day again and should then subside.  I told my surgeon that I had read that some people have them tightened regularly and he said that it was not neccessary if you could have one tightening under a GA.
 
I will, of course, let you know how I get on.
 
Two-three months after it has been tightened, my surgeon has told me that he will see me again and, under a GA, cut my seton out.  He said that although he can just leave it and let it drop, it would be better to remove it once it has done its job.  This will involve a small incision (similar to the fistulectomy) and packing for about five days.  The other alternative is to leave the band in which I do not want because once this is over I jsut want to forget about it!!
 
One thing to note, the seton drains as well as cuts.  The drainage element, for me, is the worse of the two because the drainage can smell and can cause chafing (nappy rash).  I use a gauze to catch it, change said gauze twice a day and use sudocrem on the other cheek to stop the soreness.
 
NB: If you are in the UK, purchase a pre-payment certificate from the pharmacist so that for a flate fee of £30 c. all of your prescriptions are covered and you can get all of your dressings etc - you will need lots of dressings!!
 
The experience isn't ideal and I know it's embarrassing but don't give up.  Get it sorted by somebody who knows that they are doing and you will be fine.
 
I do not have chron's and this has been ruled out but I hope this post helps.
 
 
D x

seraphina
Regular Member


Date Joined Apr 2010
Total Posts : 39
   Posted 12/5/2011 9:28 PM (GMT -6)   
Thanks so much for posting this.  I think the more people relay what they experience from fistula surgeries of all kinds, helps educate and make others aware of what is going to happen when they go through the surgery.
 
I have been considering a cutting seton so I'm very interested in hearing what you final experience is with it. 
 
Thanks for posting your experience, I hope you continue to heal well with no problems!

DJL81
New Member


Date Joined Dec 2011
Total Posts : 12
   Posted 12/6/2011 3:32 PM (GMT -6)   
You're very welcome. If you have any questions feel
free to ask D x

PITA1972
New Member


Date Joined Sep 2011
Total Posts : 10
   Posted 12/7/2011 9:57 AM (GMT -6)   
DJL81 - I am scheduled to get my seton stitch out today - in about 20 minutes (ughh) I am a bit stressed about this. It is still draining a bit. I hope it can come out... like you I want this to be over!
Was your's still draining when they took the stitch out?

DJL81
New Member


Date Joined Dec 2011
Total Posts : 12
   Posted 12/7/2011 10:32 AM (GMT -6)   
Hi Pita
 
Mine is still in - comes out in February next year.
 
Please let me know how you get on
 
D

pb4
Elite Member


Date Joined Feb 2004
Total Posts : 17880
   Posted 12/7/2011 1:38 PM (GMT -6)   
just bumping!
bee propolis caps 500mg one cap twice/day
omegas 369 caps one cap twice/day
probiotics 10 billion cfu once/day
vitamins C-calcium ascorbate (easy on the gut) and vitamin A each once/day
Prodiem fibre supplement one cap before bed
I've also altered my diet (no junky stuff at all, processed, fast-foods, refined sugars, ect) and exercise regularly.
I went from 30+ bloody BM's/day with lots of lower back pain to an average of 5/day no bleeding no back pain and completely formed stools, still have severe urgency issues.
~~~~~~~~My bum is broken....there's a big crack down the middle of it! LOL :)~~~~~~~~

PITA1972
New Member


Date Joined Sep 2011
Total Posts : 10
   Posted 12/7/2011 2:11 PM (GMT -6)   
So it went well, a little discomfort when he was taking the stitch out. I will be back to sitz baths 2 to 3 x daily until it heals (about 3 weeks). It is a bit uncomfortable now, but I think that is because of the location(plus I am at a sit down job). It will be nice to go home tonight and have a soak. There is a little blood oozing, but he said that was to be expected. Provided there is no other issues, I am in the clear.

I hope all goes well for you in February

DJL81
New Member


Date Joined Dec 2011
Total Posts : 12
   Posted 12/7/2011 3:25 PM (GMT -6)   
Yay!!! Go you x I am sure it will be better shortly. Just think no rubber band and Christmas to take your mind off it x well done!!!

dinkley
Regular Member


Date Joined Feb 2010
Total Posts : 107
   Posted 12/8/2011 3:47 PM (GMT -6)   
Great post - thanks for the detailed information!

DJL81
New Member


Date Joined Dec 2011
Total Posts : 12
   Posted 12/8/2011 4:07 PM (GMT -6)   
@dinkley you're welcome x holler if you want to ask me any questions D

DJL81
New Member


Date Joined Dec 2011
Total Posts : 12
   Posted 12/12/2011 4:47 AM (GMT -6)   
Pita, how are you doing now? x sorry to bother you but did you ever get more pain after strenuous exercise? My car broke down and I had to push it off the road and my seton now feels sore. Do you know I you can accidentally tighten it or make it cut more?

freindlyfeline
New Member


Date Joined Nov 2011
Total Posts : 11
   Posted 12/14/2011 10:57 AM (GMT -6)   
Hi D,
 
Thank you so much for posting your info. I have read it and found it really helpfull and it's so nice to hear that someone knows excatly what your going through. I had my first operation on the 15th Nov ( part 1) a fistula which was laid open ("fistulectomy") however only the upper part was laid open as the surgeon thought it best to place a Seton in as it was going through a little more muscle than he liked and didn't want to cause me problems in the future. He explained that it;s a bit like a cheese wire effect moving down allowing the fistula to move downwards so that there wouldn't be so much muscle to cut. ( guess that's what's called a cutting seton) he didn't really say. So the 1st week was horrible having the packing and dressing done, i'm on week 4 now getting no pain, life is better no more nurses for a while.  The cut is draining all the time i guess that's normal. Next operation is now on the 10th Jan, which i dreading i think it;s going to be worst as it;s the lower part ( going from bottom hole upwards) the surgeon explained that yes there will be a cut and it will be laided open. this terrify's me, how will i beable to go to the loo.    Then hopefully one final operation just to give it a scrape he said, make sure nothing is forming again. did you have that? how long until you felt normal again. 
 
thanks so much
x

DJL81
New Member


Date Joined Dec 2011
Total Posts : 12
   Posted 12/14/2011 11:07 AM (GMT -6)   
Hey Feline thanks for the post! So you had your operation four days after me? And it seems that we also had the same operation. I was getting so much betterBut then over excreted and am a but sore now though. I completely  understand how you feel. It's nice to be on the road to recovery. I wouldn't be scared about your next op; you most pro ably had the same worries about your first op and it all went well. Have you had yours tightened? I'm due that on 23rd december eeek! How are you coping with the drainage element? I got really bad nappy rash but then used sudocrem and that seemed to help; I still get it on and off. Did your surgeon tell you how long the seton will stay in you for? Mine said three months in total so there's light at the end of the tunnel!! I'm in the UK where are you based? Ps apologies for the typing. My fingers are too fat for an iPhone lol

DJL81
New Member


Date Joined Dec 2011
Total Posts : 12
   Posted 12/14/2011 11:08 AM (GMT -6)   
Excreted = exerted lol

freindlyfeline
New Member


Date Joined Nov 2011
Total Posts : 11
   Posted 12/15/2011 9:32 AM (GMT -6)   
Hi D, thanks so much for your reply,
 
My next op is on the 10th Jan, he hasn't tightened it but did fiddle a little when i went to see him at the 2 week post op checkup. I'm in the UK ( South East) 25 miles west of London. He didn't give me any idea about how long it will be in , i got the impression that the next op he will remove it.  Blinkin well hope so and then the final op will be  a scrape over he said to make sure nothing has come back.  The drainage side of things isn't too bad, just a little bit of discharge i'm suprised to still have discharge but i guess if you have a seton at the bottom of the incision then it's open all the time. I'm lucky no rash ( poor u).  I have two young kids, 6years and 2years so find it tiring with them and have to remember like you said not to get carried away.  Let me know how the tightening goes. How long is your fistula? mines fairly long about 2inches. Where you cut from bottom up? how was that and did you cope.
 
xxxx    

DJL81
New Member


Date Joined Dec 2011
Total Posts : 12
   Posted 12/15/2011 9:49 AM (GMT -6)   
Hey! I'm in Manchester city centre. I went to the doc and he told me it jut needed adjusting and it feels better three hours later!! Glad no rash for you! Mine was about two inches but after it dropped a bit he cut some off donor didn't rub. Feel for you with two kids but I bet they cheer you up a bit. I'm a gay man with a sore arse so there is a joke there lol albeit my boyfriend packed me everyday (bless him) we should keep each other posted. I will after the tightening next week.

DJL81
New Member


Date Joined Dec 2011
Total Posts : 12
   Posted 12/15/2011 9:51 AM (GMT -6)   
Sorry I thought you were talking about your seton. My fistula is about just under two inches at the top bear where the bum cheek touches the back but then it goes in and who knows where lol. My first one was 5" x 2" so this one is much better lol x x

freindlyfeline
New Member


Date Joined Nov 2011
Total Posts : 11
   Posted 12/15/2011 3:28 PM (GMT -6)   
Hi D, your last post did make me laugh. you on facebook????

DJL81
New Member


Date Joined Dec 2011
Total Posts : 12
   Posted 12/17/2011 12:55 PM (GMT -6)   
Follow me on Twitter @ vileginger

freindlyfeline
New Member


Date Joined Nov 2011
Total Posts : 11
   Posted 12/26/2011 3:25 PM (GMT -6)   
Hello D, merry christmas to you. Just wonder how you got on the other day with going back to your consultant re the tightening?  When you have your next op???  cheers freindly x
 

DJL81
New Member


Date Joined Dec 2011
Total Posts : 12
   Posted 12/27/2011 4:02 AM (GMT -6)   
Hey Feline. Merry Christmas to u and thanks for thinking of me. The procedure went well I suppose. Went under a GA and came round two hours later. Was sleepy for the rest of the day but my consultant gave me a further local apparently so no pain on day zero. Day one got up and drove two hours to my fella's family for Christmas and apart from having to find a comfy position for the festivities, was pretty much ok a lot more drainage is coming out and it is slightly pink so I assume it is literally cutting more but my consultant hopes it will be out in February. One thing I did this time was take fybogel and lactulase twice a day for a week before my op and I'm still taking them both now. This avoided the after anaesthetic constipation for which I am glad x all of the previous pain referred to above was constipation so I can't recommend it enough. Hope you're well and let me know how you're getting on. Are u following me on twitter yet? Let me know so I can follow back x

waitingforacure4cc
New Member


Date Joined Dec 2011
Total Posts : 9
   Posted 12/27/2011 9:49 AM (GMT -6)   
My husband (diagnosed with Crohns 20 yrs ago) has had 2 setons placed in 5 years for one fistula, one was a cutting seton and one a regular elastic band just to keep the fistula open and draining.    Both fell out and both required surgery.  His body was rejecting them and each time we went in for surgery there was cutting and muscle loss.  Eventually too much cutting will lead to incontinence so we had to find a better way. 
 
After being on Colazal, mesamalanine 15-20 pills a day with nulev and steriods intermittantly, my active handsome 40 yr old husband and I took a chance on the drug remicaid.  Remicaid is an IV infusion administered every 6 weeks (dosing and space btwn treatments vary).  with remicaid and a switch to Asacol (only 3 pills a day vs 15-20) my husband has been healed from his fistula with NO seton in place for 2 years.  His trips to the restroom have gone from as many as 20-30 a day to 3-4 depending on if he eats trigger foods and best of all, his confidence, quality of life and ability to really live a full life with me and our family is now a reality.
 
There are some downsides to remicaid....Price is high, but Johnson and johnson have patient assistance programs in place.  Remicaid IV is every 6 weeks for 3 hours and he spends 4 days post infusion with a migraine that would kill a horse, however, once his gas tank is full of remicaid he has 4 good weeks, symptom free (yet always cautious).  In week 5 his body is low on remicaid and his symptoms come back toileting increases, pain comes back more intense and he needs his fix.  while this isnt a cure, it has given him and our family 2 years of hope, normalcy and a lot of time in the car and outside.
 
Upsides:  all the things we can do now, but best of all, his last colonoscopy the first in 20 years showed healing and a healthy colon.  the Dr said that if he did not know my husband had Crohns he would have thought it was a typical patients colonoscopy pictures.  Now that is a blessing and it is all thanks to Remicaid and having the beliefe that for loved ones with CC there is a better way!  Always have hope and always keep trying.  We are fighting for a cure.
 
Stay positive and learn more about remicaid, it worked for us, maybe it will work for you.
 
 

freindlyfeline
New Member


Date Joined Nov 2011
Total Posts : 11
   Posted 12/27/2011 10:35 AM (GMT -6)   
Hi D, i haven't been on twitter b4. not sure how it works, when i get a moments peace i may look at it. glad it all went alright. just got back from a day in london with the family, knackered now. happy new year to you. xx

freindlyfeline
New Member


Date Joined Nov 2011
Total Posts : 11
   Posted 1/15/2012 3:31 PM (GMT -6)   
Hello D, hope you are well and enjoyed new year. I have had my 2nd operation and have been disappointed as it wasn't as big as op as i was hoping. My consultant has left my seton in place. i guess he tightened it but he never really said, he found where the 1st round of laying open the track was a small cavity formed so he cleaned that out. He wasn't happy about cutting through the muscle yet and said he was thinking about me and the future, i so understand and do deep down know it was the right thing NOT to lay open the rest of the track. It's just i had prepared myself for somthing truly horrid and it didn't happen. i didn't know and understand when i first embarked on this route of operations that it would be like this and go on and on. Very bruised and soar right now. Although i am fairly suprised that the pain isn't as bad this time. hope your doing ok. cheers freindly.

neversurrender
New Member


Date Joined Jan 2012
Total Posts : 2
   Posted 1/16/2012 12:12 AM (GMT -6)   
Hey I posted this in another thread and thought I would share here too in case you miss it.

"blankstare. I know your pain friend. I was in Africa when I got my abscesses and couldn't come back into the states until a month later. The 15 hour plane ride back was one of the worst experiences I had to endure. Being by myself carrying a desktop computer, professional camera equipment and luggage and getting no sleep in pain and having to sit on my abscesses was so terrible. I had two large original abscesses on both sides of my bum. Had surgery to remove them, and one side healed over a year ago and the other I am still dealing with. Since my first surgeries where I had the abscesses removed they were packed by my mother (thanks God for her) with string gauze because it had to heal from the inside out. The bad side then required me to have a seton put in because it developed into a fistula which was causing the terrible pain before. This was then preparation for a fisutla plug which was a degradable plug which your body grows into. The fistula whole was left so it could still drain while it would heal. I thought everything was going fine until the pain never seemed to go away and I still noticed stool coming out of where the plug was put so it was a failure. Plugs usually work around 60% my doctor said so it was a risk to take. This procedure I remember was pretty rough on the pain scale. I finally got a cutting seton put in after the plug was gone and the fistula track was still there. I wasn't willing to go back into surgery so I actually endured this sober and awake which was a terrible experience with my doctor opening up my rectum and threading a cutting seton (rubber band) through the fistula. I would then go in every 2 weeks to have the rubber band tightened and it would cut through the skin making the fistula heal behind it and make the track smaller as time goes by which it eventually fell out.

Right now, I would say the cutting seton was the best procedure I could have done out of the 3, but it can cause older people problems of stool control because your muscles are cut through and there is a crevasse made. I however am pretty young at 23 and I have no health risks to affect it. The cutting seton did great, but I am still having problems of little random abscesses/infections buildling up in different areas around my old scar tissue. I have had to have them opened a few times which then heal up pretty quick. So I am just playing it by ear right now.

I am sure he ended up putting the plug in you. Let me give you some advice on how to take care of yourself and keep your head up:

1. Go buy powdered fiber. I use Konsyl Fiber Supplement. It does WONDERS! Take before or after every meal you take. DONT TAKE THIS DIRECTLY AFTER SURGERY due to being constipated from the pain medicine from the surgery. DRINK PLENTY OF WATER with this! This will keep your stool together and to where you wont have to wipe/getting in your infected areas. (http://www.sjunkie.com/wp-content/uploads/2011/10/konsyl-g.jpg)
2. Do not wait to see if you will heal over a long period of time. I recommend getting checked up fairly soon after your surgery. I waited a while after I got my plug and even though it wasnt working I still avoided going back right away which just caused more pain. Hopefully it works for you!
3. I see you are already taking sitz baths. KEEP TAKING THEM. They also do magical wonders to the healing process.
4. Get square gauze pads. I use all kinds but there are gauze rolls that roll out and you cut them and fold to put in your crack. This will help so much on keeping your lining between your legs dry and I would change these out alot. You will be having to buy alot of this stuff. (http://image.made-in-china.com/4f0j00ZeYEtwQGsubv/Gauze-Roll.jpg)
5. Keep clean! Eat clean! So important.
6. Don't lay down too much after surgery. You will get constipated very fast and the pain medicine in you will make it happen easier. Drink plenty of water!
7. Smile and be positive. My doctor and I have become good friends and he treats me as he would his son. He tells me stories of those he has to take care of that are dying and have much worse problems than I do. Trust me, this is the most painful thing I have ever had to experience, but I am alive and have come to realize that abscesses/fistulas are very emotionally and physically testing.
8. Try to get on a good schedule. Once you find some type of good schedule it will help out your social life and will help you stay positive about your situation.
9. Know that you are not alone. So many people have this problem you just dont hear about it. If you need to talk just respond here and I will bookmark this thread.
10. For your sitz baths get the liquid soap and put like 3 squeezes in to help sanitize the water.
11. Get a small mirror and check yourself and try to make sure nothing new comes up, if it does then IMMEDIATELY go to the doctor to get it checked on. As much as you hate going back for something new, YOU HAVE to go asap. Otherwise it could get nasty again."
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