I don't have experience with fistulas that are sneaky and stay on the inside like yours, but I've been through the surgeon routine enough to throw at least a couple things out there.... hopefully someone with a case closer to yours will follow along soon.
#1 How invasive is the surgery being performed, and what are the IMMEDIATE risks (i.e. puncturing something or the likes) I never feel bashful about asking the surgeon directly how many times he's performed the procedure and any complications that he's experienced. A surgeon is, in the end, a businessman, and you have the right to "shop around" if you don't feel comfortable. I can't stress enough how important it is that you feel COMFORTABLE with your surgeon if at ALL possible. A sore bum is enough to worry about, so you don't necessarily have to LIKE your surgeon, but you need to trust him/her.
#2 How successful is this surgery method for the problem at hand? I would get recurrence rates, for sure. SO many of the surgeries that are popular for crohnies seem to start a never-ending cycle of surgeries, so make sure this one is going to GET you somewhere.
#3 Get a defined "title" for the surgery (i.e. my experience is with peri-anal "Incision and Drainage" surgeries. Make sure you have a name for the surgery in case you feel like "googling" it or asking more surgery-specific questions. It sounds like a no-brainer, but there are so many different methods and names for this stuff... and surgeons like to look like they're in a hurry, but I don't care - take the time to get the answers, darn it... I've used the following line three times myself: "I realize that you are over-worked and spread really thin, but this is my body, and it's the only one I get. I have more questions."
#3 What medications are going to be administered in relation to the surgery and what are THEIR possible side effects (i.e. are they gonna shove you on steroids and if so, for how long... antibiotics, etc.) It's always good to know what they're "brewing up" for your belly and make sure that you're comfortable with their prescription plans.
#4 What alternatives to surgery do you have? The surgeon might think it's a "done deal", but you have a right to know if there's a chance that 4 months of a certain medication could accomplish the same end result, or if there is an alternative of ANY kind to this surgery. Getting sliced is usually a last resort, so make sure they're not jumping the gun.
I'm sure I'm forgetting stuff, but the last thing I can think of is to get all these questions answered, do some more homework, and then decide if you're ready to proceed. Don't let them boss you around and tell you that you have to schedule it for this week if you're not comfortable and prepared to do so. If you've got a good surgeon, and he answers all your questions and you feel confident that this is what needs to be done - then by all means go for it. But if you're hesitant, or still have unanswered questions, keep badgering someone until you have all the pieces you need.
26f, dx'd CD July '05 after 6 fistula/abscess surgeries
Currently running on Humira and Hope.
(miscarried at 13 weeks, now waiting to heal before trying again)
"Our greatest fear is not that we are inadequate, but that we are powerful beyond measure."