Surgery for Fistulas

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Crohnie1983
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Date Joined Dec 2007
Total Posts : 5
   Posted 12/13/2007 9:17 AM (GMT -7)   
I am having surgery for some rectal fistulas and I was wanting to know if any of you could tell me what this is going to be like. They are going to use conscious sedation, which I am kind of nervous about. This is my first surgery and I am trying to keep calm, but am pretty nervous. After the surgery I am going to start on Remicade, so if any of you have any advice on that as well, it would be very helpful. I have a relative who did not do well at all on the Remicade, but it made her worse. So any advice would be awesome!!

Thanks!!!

chroniemomx2
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Date Joined Apr 2005
Total Posts : 2346
   Posted 12/13/2007 3:47 PM (GMT -7)   
I would try the remicade before surgery for the fistulas. If it is a fistulatomy, I would use general anseth. I used conscious sedation when I had a seton placed in my fistula. I have had my seton in for just over a year, and it has migrated nicely to where my surgeon believes it hardly any muscle involvement. He is going to do an exam under anesthesia in March, and if it is the way he believes with no/little muscle involvement he will do a fistulatomy.

MDdave
Regular Member


Date Joined Nov 2007
Total Posts : 74
   Posted 12/13/2007 6:53 PM (GMT -7)   
I had five surgeries in 3 months I was in so much pain before the surgery that I could not sit but to one side of my butt and had to use a donut to sit on for driving. The surgery I had back in 97 the dug out the fistulas like someone took a melon scooper to my rear very close to were the mussel that control
your BM, after my fifth operation the surgeon said he could not operate anymore do to risking me of
all loss of mussel control. They ended up drying them up by placing me in a ileoostomy as the remicade was very new back then and I was far too gone to be a patient of the drug.
I understand now that the new drugs help contain the fistulas activity.
The surgery it's self was not as bad as the suffering that was going on prior to the operation.
I would ask you doctor if it’s not too late to try the new meds before surgery...one operation will be
less complicated the five I had all so close together, that time frame for me was all a blure and a painful one at that. I was at my ends whit and just told the surgeon to do what ever he had to just stop the pain.

Good Luck

straydog
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Date Joined Feb 2003
Total Posts : 13473
   Posted 12/13/2007 7:15 PM (GMT -7)   
Crohnie, there has been quite a few peeps on here that was successful in getting their fistulas to heal with Remicade & Imuran and I think Cipro. If I were in your shoes I would give it go before surgery. Remicade has its side effects just the same as any other drug. Many here have been on it, are on, loved it or hated it. I was on it for 3 1/2yrs and I did very well on it. I had a reaction in the beginning and was given IV Benadryl & Soluable Medrol. This happened when the rate of the drip had been increased, which is common if you are going to react. The infusion was stopped, waited a bit, resumed the infusion at a slower rate and I had no further problems. From that time on I was given pre-meds and had no problems. We stopped Remicade because it was losing its effectiveness with me. Hugs, Susie


Crohnie1983
New Member


Date Joined Dec 2007
Total Posts : 5
   Posted 12/13/2007 7:23 PM (GMT -7)   
Thanks for your input. I am still really nervous about this sugery. I am actually scheduled for surgery on Tuesday, but I don't want it to lead to more surgeries; unnecessariy ones I mean. Maybe I should talk to my surgeon and my GI doc about it. My colo-rectal surgeon was so avid about doing the surgery and starting the Remicade. Maybe it won't be as bad as I think.

9ball
Regular Member


Date Joined Mar 2007
Total Posts : 57
   Posted 12/14/2007 6:49 AM (GMT -7)   

Hi,

My daughter has had 3 remicade treatments and her fistula has healed. But an old abcess she had before she started the remicade is back. We hope it heals also. She has not had any reactions to the medicine.

Angel's Mama

dragonfly137927
Veteran Member


Date Joined Sep 2006
Total Posts : 2527
   Posted 12/14/2007 9:05 AM (GMT -7)   
I am going to be having surgery for my enterocutaneous fistula in January or February. I had a fistulagram this past week and having a colonoscopy Thursday. The colorectal surgeon is having these tests done first to deteremine what part of the intestine is flaring...my CD use to be limited to my ileum now from the fistulagram it appears as if it has moved to my large intestine. He wants to see how much he has to remove and how distal/proximal the fistula is. I have tried all other methods to heal it and Sx is the last option.

I use to be on Remicade back from 2001-2006 My first CD related Sx was in february 2007 then had 2 more after that one this year with complications after each of them. I was placed on Pentasa after my ostomy reversal hoping that would keep the CD from returning so fast, that was in late July my reversal was in late June. Unfortunatley I was already having severe pain on my L side when I was placed on it. That pain was later lessened once the fistula finally broke through the skin in Sept. When the pain began they docs felt as though it was just the post op pain still.

I started Humira initially it was for my joints since those have given me the most grief these 20 years that was why I was placed on remicade too. I had tried celebrex and otehrs like that and after 1 week I would flare so that was what got me on remicade. In later 2005 early 06 I started having bad reactions to the remicade during the infusion casuing me to have to prep with pred the day before and day of the infusion. My GI that I have now sent me to a RA doc to verify that the arthritis was CD related and not a diff typ;e also he wanted to verify that the RA doc felt Humira was my best option. I was also placed on Entocort back before my ileum perforated back in dec I think I was placed on it. My new GI also placed me on it when my joints were acting up he said usually when the joints flare it means the large colon is flaring...I thought that was odd being that my joints as stated above was always my biggest problem and the CD was never in my colon until this year after my surgeries.

I was placed on humira and was awaiting the authorization to go through and a cpl days later that was when my fistula came thru. The humira seemed to help but I was finding that the fistula drained more when I was getting close to my next injection. I was on the traditional CD dosing for a few3 months and just last month my doc increased the humira to 1 shot each week.

My surgeon finally saw how bad the fistua was and I went to him since my GI wanted my surgeon or my PCP to scriptout pain meds since he didnt feel comfortable giving me any since I need the stronger pain meds since vicodin, darvocet, and percocet dont do a thing for me I need things like dilaudid and fentanyl. I was placed on ABs by my GI and had set up the appt with my surgeon so he could see the fistula since most times I would go to him it was not long after my humira inj so it didnt appear to be too bad. So 1 week after being on cipro it didnt do a thing so my surgeon had a picc line placed in me and I was on TPN...that didnt help either mucosa actually came above my skin...that had happened to me before it was minimasl drainage for a cpl days then it looked like a blister would appear near the opening then the mucosa would pop out he had not seen that on me since it goes back in then out again. I had the picc pulled because it got infected and he determined Sx is what I need.

I would definitly use all other options to try to heal it first before Sx and if Sx is a must make sure you have all testing done that your doc and surgeon suggest
Dx with Crohn's 1987, symptoms as early as 1984.
Temp iliostomy February 2007, reversed June 2007, Ovarian cysts, migraines, allergies (incl food allergies) , oral allergy syndrome (diff than true food allergies), Asthma, Gall Bladder removed 1999, Inguenal hernia 1987
 
 
 


FallColors
Veteran Member


Date Joined May 2007
Total Posts : 1220
   Posted 12/14/2007 10:10 AM (GMT -7)   
Hello Crohnie,

I have a remicade infusion in about an hour and am very glad for it. I have a rectal fistula with seton and am much better for having the drug! Please remember that surgeons like to operate. It is what they do, what they like to do, the only thing they get paid to do, and unfortunately they often jump right to that as if it were the only option. GI docs on the other hand usually consider all the options. I would call your GI doc ASAP and make sure he/she thinks surgury NOW is the best course for your condition.

Let us know how it goes!

Crohnie1983
New Member


Date Joined Dec 2007
Total Posts : 5
   Posted 12/14/2007 11:25 AM (GMT -7)   
Well it looks like I will be heading into surgery first. The anticipation is rising!! Not that I feel that it's a great thing, but relief is always a great thing!

I will definitely let you know how everything goes!!


THANKS A MILLION!!!!

Crohnie1983
New Member


Date Joined Dec 2007
Total Posts : 5
   Posted 12/14/2007 11:39 AM (GMT -7)   
PS...I am glad that I found you guys! I am learning alot and it is definitely helping me cope!! Just knowing that there are people who understand and who have been there means the world!!

God bless you all...and Merry Christmas!

sip612
New Member


Date Joined Jan 2006
Total Posts : 1
   Posted 12/16/2007 8:10 PM (GMT -7)   
Hey,
 
I had surgery to drain a rectal abcess back in April and another popped up in October so the setons are back in.  In between I started Humira but needed to stop it once the second abcess needed to be drained.  The surgery is actually pretty quick, probably a total of 20-25 minutes tops.  I'm on Cipro and Flagyl now which are allowing the abcess to drain, although they have their drawbacks!  The setons have been a big help for me, although I am really anxious to be back on the Humira.  You should be fine!  Good luck and Merry Xmas!

chroniemomx2
Veteran Member


Date Joined Apr 2005
Total Posts : 2346
   Posted 12/16/2007 8:36 PM (GMT -7)   
Hey sip612, I have had many rectal abscesses, and I am on remicade. I have never stopped taking the cade because of them. That is part of the disease, you need the humira. The setons should stop the abscesses, but get back on the humira.

Crohnie1983
New Member


Date Joined Dec 2007
Total Posts : 5
   Posted 12/17/2007 9:00 AM (GMT -7)   
Well tomorrow is the day!! I am nervous, but pretty ready! Glad to know that it only lasts about 20-25 minutes! I go in at 8am and am scheduled for surgery at 9:30 so I will have a nice day to rest up.

I will let you know how it goes!
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