Hi Sore Tum,
I've had the setons in for over a year. The doctor called it a Stage 1 fistulectomy. He explained that setons keep the fistula open, which allows "stuff" to drain out and not get trapped and abscess. With things draining, and usually with antibiotics, any infected tissue around the fistula and old abscess can heal. The next stage of the fistulectomy procedure is when they cut open teh fistula. This distroys the fistula tube and then it can heal like normal tissue. They don't sew it closed, rather it is allowed to heal from the inside out. If they sitch it closed, bacteria usually gets in and then -- abscess!!!
But if the origin/start of the fistula is high in the rectum, then cutting the fistula open would require cutting through sphincter muscle. You would be immediately be incontinent because the sphincter muscle will never heal properly. That is the case with mine -- too much "sphincter involvement."
There are two other procedures my colorectal surgeon said were options for me. The first is the fistula plug, where they thread a wick-like string through the fistula. Your tissue grows into the wick and so the fistula closes. This procedure is successful only about 60-70% in non-Crohn's people and only 40-50% in Crohn's (we just don't heal as well). The other option for me is the Advancement Flap Procedure, where they cut a flap of tissue right beside the fistula opening, fold it over the opening, and stick it closed. Success rate is 80-90% in non-CD and only 60-70% in CD.
Here are two good websites that provide information about fistulae:
http://emedicine.medscape.com/article/190234-overview --- this continues on several pages, so be sure to click on the sections, especially "Treatment"
I am in no hurry to try either the plug or flap procedures. I really, really hate abscesses.
Right now I'd rather live with my setons then risk an abscess. My doc says there is no medical reason to get rid of the fistulae -- I could live the rest of my life with them. He said I can always change my mind later.
I suggest you search previous threads about
living with setons. Lots of great advice from experienced people on caring with skin irritation, cushioning setons, and cleaning them -- oh and the color of setons. I've had blue, and white ones, and now have a very fashionable red.
I got a hand-held shower sprayer and use that to clean them. I put one foot in the bathtub and the other foot outside and then sit down and spray away! Then I wrap them with clean soft 4x4" guaze pads. They guaze catches the little bit of drainage and keeps the sharp knots of the setons from poking me. I find life is not bad at all with setons.
Diagnosed with Crohn's in early 2007. Several peri-rectal abscesses and two fistulae with setons. Allergic to Remicade and Humira. Currently on 6MP, and vitamins D and B-12.