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Dimitri71
Regular Member


Date Joined Jul 2017
Total Posts : 63
   Posted 10/21/2017 12:36 AM (GMT -7)   
After three months with a seton in site (draining) it is FiLac time surgery for me on Wednesday.
I have a mid to high transphicteric fistula, not an easy one.

FiLac (Fistula Tract Laser Closure) is a laser surgery that is non-invasive (a laser goes inside and burns the fistula instead of cutting it out). It is used mostly in Germany and in Italy. It's similar to VAAFT and becoming more and more accepted as a solid, non-invasive alternative.
I have decided to go with it as a first approach.
Based on some studies it has a 70% success rate, so I am fairly optimistic.
In case this fails I would go for LIFT or FLAP or Plug (or maybe another try with FiLac, depending on the results)
I will try and keep this thread updated, although as you all know it is a long-term process.
All the best to everyone and god bless.
Dimitri

73monte
Veteran Member


Date Joined Mar 2007
Total Posts : 1762
   Posted 10/22/2017 2:48 AM (GMT -7)   
This sounds very promising. Surprised I haven't heard of it. Hope it works for you. Let us know how things go.

Dimitri71
Regular Member


Date Joined Jul 2017
Total Posts : 63
   Posted 10/25/2017 8:08 AM (GMT -7)   
So I am back to confirm that I had FiLac.
I am still above the ground which is good (you're never sure with these things)!
Again, in the same manner as with my seton drain surgery (3 months ago) I feel almost 100% three hours later.
When I had my seton drain surgery, I was able to quickly bounce back. Next day I was playing basketball with my kids. It was a bit crazy but my CRS gave me the clearance and I did it.
For sure I will try the same tomorrow!
In terms of the results of the surgery:
My CRS told me that the seton (which was removed today) did not really create as much fibration as he expected during the last three months (go figure but it does not sound too good). Yet, despite this he is optimistic.
From what I've seen he must have laid open the superficial part of the fistula (outside the sphincter) and performed Laser (FiLac) on the rest.
No pain for now. I'll have to wait and see. I get antibiotics for 1 week and probably will take some painkillers if it hurts later at night.
I'll keep you posted in regards to any evolvements.

Dimitri71
Regular Member


Date Joined Jul 2017
Total Posts : 63
   Posted 10/26/2017 12:06 PM (GMT -7)   
I had the FiLac surgery yesterday.
My recovery in terms of pain is fine, I feel almost 100%.
However, I have draining (significant) and I feel like the surgery has already failed!!!
I just called my surgeon (he is used to me crying over his shoulder) and I will meet him on Monday for follow up...
To describe my feelings I am quoting a Johnny Cash song:
"Six foot six he stood on the ground,
He weighed two hundred and thirty-five pounds,
But I saw that giant of a man brought down to his knees by love."
Just replace love with Fistula and you got it!

nofistulas
New Member


Date Joined Oct 2017
Total Posts : 15
   Posted 10/27/2017 12:02 AM (GMT -7)   
oh man sorry to hear that. that sucks. i was thinking about filac myself and was curious about the healing time.

i understand that drainage is normal - but i guess the question is how much and type of drainage, right?

hopefully this is just a part of the healing process. let us know what the surgeon says.

Dimitri71
Regular Member


Date Joined Jul 2017
Total Posts : 63
   Posted 10/27/2017 10:58 PM (GMT -7)   
Thanks nofistulas, I will.

Memmem
New Member


Date Joined Oct 2017
Total Posts : 11
   Posted 10/29/2017 2:10 PM (GMT -7)   
Sorry to hear that man,I hope the fastest full recovery..The laser burnt the infective tissues,body has a higher chance to beat it up,hopefully it will aid it.I read in papers that second filac increases the full recovery chances even more which I think you heard too.

Hang in there man.

Dimitri71
Regular Member


Date Joined Jul 2017
Total Posts : 63
   Posted 10/30/2017 2:31 AM (GMT -7)   
Thanks Memmem. I am at work today (1st day post op) wearing my wive's sanitary staff and supplies along to control drainage (ha-ha, I never even imagined this could happen, but you have to be humble in life).
I agree with you. I have read indeed that the 2nd filac surgery improves the chances (1st has a 60%-70% success rate and the second around 80-90%) however if you read the specific paper (author is a german CRS expert in Filac, named Wilhelm) it is quite tricky: The second surgery is not Filac in most cases, it is fistulotomy. Fistulotomy can be performed in the second stage because the fistula has become smaller (e.g from transphicteric it becomes intersphincteric).
So this parameter raises the success to 90% on the second try!

That is an interesting positive effect that the failed 1st FiLac surgery tends to have in about 50% of the cases (which is similar to the after effects of a failed LIFT surgery).

Let's wait and see: To be honest I have to see to believe. I am meeting my surgeon this evening after work to have a first follow up. I will keep you posted.

Dimitri71
Regular Member


Date Joined Jul 2017
Total Posts : 63
   Posted 10/30/2017 10:50 PM (GMT -7)   
Hi Folks,
I am updating as I feel it is imperative, in order to help others in the forum going through a similar thing.
I went yesterday to my CRS for a first update following my FiLac surgery.
The draining continues to be quite a lot. He said that the draining is not pus but various other reconstructive substances (serum etc). I am not sure I'm buying this, as I am also on antibiotics since the surgery (and he asked me to continue till next Wednesday, I believe that this could have an effect on the type of draining; anybody any experience with antibiotics after surgery and its effects on draining??).
He also said he "liked" the way the wound is healing, so that's good as well.
Unfortunately, when I asked him about my chances for healing, he gave it a 50%-50%. He attributes that to a technical detail he also pointed out immediately post surgery: The fact that the seton had not managed to fibrate the skin around it as effectively as he would have liked to. As a result, the laser diode may not be as effective in burning all the parts of the fistula. Mind you the original chances were higher - circa 70%+ concerning the first attempt - and 95%??smile concerning the second attempt.

To cut a long story short, one has to wait for around 8 weeks in order to confirm whether this has worked or not. Which means wait till CHRISTMAS. Which makes me feel that, I'll have a blue-blue Christmas (WITH my fistula).
I am still hoping, but I am certainly less optimistic now.
I am slowly going back to sports (running etc.) as the pain is limited and trying to focus on other things in order to forget this for a while...
I wish you all the best.

Post Edited (Dimitri71) : 10/30/2017 11:54:55 PM (GMT-6)


nofistulas
New Member


Date Joined Oct 2017
Total Posts : 15
   Posted 10/31/2017 12:21 AM (GMT -7)   
hmm. interesting. that's good information thanks. I've had more surgeries in the last two years than I can count and I've never been given antibiotics afterwards so I can't speak to its effect on drainage. but i'm curious if the drainage is clear, thick, color, smell? you can probably tell if the drainage is from stool leakage based on color and smell usually.

generally if the tract has not matured enough, then the seton needs to be in longer. usually 6 - 8 weeks is sort of the minimum. some have it in for 3 months before doing any fistula repair surgery.

I'm curious dmitri, how did they close up the internal hole in the anal canal? did they suture or staple? or did they not do anything and just use laser for that as well?

Dimitri71
Regular Member


Date Joined Jul 2017
Total Posts : 63
   Posted 10/31/2017 2:50 AM (GMT -7)   
Hi nonfistulas, good points.
I' ve had the seton for three months prior to the surgery as you point out so I was hoping this could help.
I've never had stool show up to now in my drainage. Prior to the surgery it was a weekly circle of fairly thick pus, slightly greenish and following that some more bloodish drainage.
Post surgery drainage is more liquid, more yellowish and pinkish and occassionally just a little thicker. It is more drainage for sure.
I am afraid that if I stop the antibiotics (in a couple of days) it will be the same as before.

Now in terms of the internal opening and FiLac, there exist two schools of thought: a) The Italian, a surgeon called Paolo Giamundo, who just uses the laser and b) the German, Arne Wilhelm who believes in shutting the internal opening (via sutures or flap or other "tricks" that I am not aware of).
My surgeon is a fan of the Italian school so he simply does the laser (very non-invasive and repeatable).
The challenge is that you need the results as well obviously.

The surgery recovery has been quite good for me (besides the antibiotics which annoy me). Today I went jogging for example. So no aches and staff.
However, at this point I am not sure if I would chose FiLac again in order to attack this demon. I am tending towards LIFT for the next time. But then again I have a lot of time ahead of me....

Post Edited (Dimitri71) : 10/31/2017 4:10:57 AM (GMT-6)


Quay Labourer
New Member


Date Joined Oct 2017
Total Posts : 3
   Posted 10/31/2017 9:28 AM (GMT -7)   
Fingers crossed it works for you, but if you were still draining pus down the seton, it sounds like there was still an active infection somewhere. That will want to keep draining, so there seems little chance the wound will heal up. I had a drainage seton installed nearly six years ago in a very high (according to my CRS) trans-sphincteric fistula, fortunately without any problems since. The CRS said there was no surgical solution without either a high chance of incontinence or a high chance of recurrence - I should just learn to live with it. In my case, the pus drainage took the best part of a year to stop. Now I eat plenty of fibre to keep BMs loose, which I'm lucky are regular first thing each day. I can then take the dog for his morning walk and the brown drainage down the seton will happen while I'm active, I can wash before I leave for work and feel clean for the day.

I was given antibiotics after having the seton installed and before, when first diagnosed with the abscess that caused the problem, but I don't think any of them had any effect, apart from upsetting my stomach.

From all I've read in the years since, the two issues with fixing a fistula would seem to be removing the granulation lining of the tract and closing the internal opening. VAAFT seems to get decent results as it addresses both, as the method recommends a suture to the opening, but would be tricky as my fistula was starting to horseshoe (the CRS description) and the VAAFT equipment is rigid. I've been pinning hopes on the FiLac method, but I'm not convinced by not closing the internal opening.

On the plus side for you, at least it sounds like you still have a full choice of options for the future if this operation hasn't worked and you're active again. Can't think of anything worse than ending up incontinent - wearing the wife's pads is humiliating, but better than that. Keep positive.

Dimitri71
Regular Member


Date Joined Jul 2017
Total Posts : 63
   Posted 11/1/2017 1:01 AM (GMT -7)   
Thanks Quay, solid arguments.
I agree with you that if you can wait for a year maybe the pus drainage would go away (but you cannot be sure). That was a concern of mine as well going in to the surgery, but I assumed that most patients going in for Filac must have at least some suppuration (since through studies I've read most had the seton in site between 2-3 months). So I am not sure. I assumed my CRS ought to have taken that in mind...maybe I was wrong.
In regards to you point about FiLac you can have both FiLac AND take care of the internal opening at the same time (e.g. FLAP). It is a matter of choice.
It regards to your drainage that's interesting, because I also have a similar fistula. How much drainage do you have now? You don't have to wear a gauze during the day at work?

Post Edited (Dimitri71) : 11/1/2017 2:04:19 AM (GMT-6)


Quay Labourer
New Member


Date Joined Oct 2017
Total Posts : 3
   Posted 11/1/2017 3:30 AM (GMT -7)   
Drainage nowadays, some brown in the mornings after a BM, generally helped to drain down the seton by a fast walk with the dog - guess you could go for a jog and get the same effect. Always wear a gauze for that, then have a wash when I get home, before leaving for work. Drainage for the rest of the day is minimal and all brown, no pus - I do wear a gauze, but that's mainly for my own reassurance, so if I do drain at all I can change gauze in case it smells. If I'm honest, I don't really need the gauze after the morning drainage, but I don't like to think my co-workers might notice any strange aromas around me. I could just forget the gauze and give the area a rinse at lunchtime in the company showers. At night, I don't bother with the gauze - nothing ever drains out, partly because I suppose whatever got caught in the fistula during the morning BM has gone by then and partly because when I'm laid in bed gravity won't work on anything that did want to drain.

This is all very different from the first year or so, when what drained down the seton was a committed green and ran all day and night. Got through a lot of gauze in that time. I know I've been lucky with the drainage seton, given the horror stories you can read online about some people's experiences with them, but after the infection went and the drainage slowed to just a slight morning dribble, I wouldn't know I've got a fistula, apart from changing gauze now and then. It would be nice to be cured of it and I keep an eye on stories about new techniques etc, but I'm not going near any operating theatre unless both the technique and the surgeon can demonstrate a 80 or 90% plus success rate and no incontinence - I just don't think it's worth the risk.

My first year was horrendous and I feel for you (and everyone else) going through it. In thatyear I'd have given my right arm to be cured, but now it's all calmed down I'm much more relaxed. Maybe in a few years, when there's a larger body of evidence behind FiLac, and particularly some research into the causes of failure, so the technique can be refined and improved, I might go for it - it seems the best possible solution available for me at the moment. In the meantime I focus on family life and try to forget about it.

Hope you find all this waffle in some way reassuring that the future is not all lost for you. At the risk of you falling off to sleep reading this, I found when researching my family history I had a great grandfather who developed a fistula in 1885, whilst in the army. His medical notes read that it was treated by being 'stuffed with carbolic acid and lint', which must have stung a bit, but sounds similar to a drainage seton. Spent over three months in military hospital being treated. He went on to live for another 52 years, married twice, fathered ten children, respected member of local community etc. I wouldn't be here if a fistula had stopped him having a normal family life. I have an old photo of him hung on the wall at home as inspiration - if he could cope, so can I. Hang in there, my friend - don't let a fistula stop you.

nofistulas
New Member


Date Joined Oct 2017
Total Posts : 15
   Posted 11/1/2017 3:31 AM (GMT -7)   
i think when it comes to fistulas, everyone is different and location along with frequency of bowel movements plays a role as well. I also had my seton in for well over a year and the drainage had no intentions of letting up - in fact got worse over time. like clockwork, every 3-4 weeks i would have to go in for an I&D surgery. I really do think that location of the internal opening and how it tracks to the external opening contributes to whether you are prone to abscessing or not. Also I usually have two BMs a day - unfortunately somewhat close together. The first one always seems okay - like I would be okay for the rest of the day. but the second one always delivered the knockout punch, where I would start to feel the pressure and swelling build up. everyone's fistulas are unique and probably why the CRS can only muster up at best 70% success rate.

Dimitri71
Regular Member


Date Joined Jul 2017
Total Posts : 63
   Posted 11/1/2017 4:51 AM (GMT -7)   
Quaye, thanks, that's a great-great story! It is a real motivator indeed. I have 3 kids but would not mind more (with the same wife).
Your situation sounds good. One thing I would investigate if I were in your shoes would be whether the fistula has "migrated" lower during this time, thus making a fistulotomy or a cutting seton feasible. Have you checked that out?

nofistulas: how are you doing post LIFT? Are you still hopeful? Has the situation improved?

All the best to all.

Quay Labourer
New Member


Date Joined Oct 2017
Total Posts : 3
   Posted 11/1/2017 5:56 AM (GMT -7)   
I quite agree with the idea that we're all different, sadly making one form of surgery unlikely to be the best for everyone.

Had an MRI scan last year after my annual check up with my consultant. The original fistula was 'horseshoe-ing round' (his phrase) when the seton got put in to control the problem. This time, he reckoned that the tract was 'straightening out' (his phrase again) and I can see that the seton is rather less tight than it was. Clearly things are on the move, but I think the tract would have to move a long way south before I can think about fistulotomy.

Maybe one day.

Karen1982
New Member


Date Joined Nov 2017
Total Posts : 1
   Posted 11/1/2017 12:09 PM (GMT -7)   
Hello, looking for some help - No chrons (determined by colonoscopy)

Filac preformed September 22, 17 for a high more Han 50% muscle fistula. I have had it drained twice and Filac was my last procedure. The doctor was able to find the track all the way through and prefer but could not push the internal.

Filac was a piece of cake no issue at all. I have been draining ever since the surgery on and off. Mine is for yellow looking drainage. This Friday will be 6 weeks. My doctor told me it could take up to 3 months to know if it worked or not.

It’s not painful I would say more uncomfortable than anything. It does seem that this week has been better but still drainage. For those who have had FILAC can you share the timeline and experience.

Dimitri71
Regular Member


Date Joined Jul 2017
Total Posts : 63
   Posted 11/2/2017 2:47 AM (GMT -7)   
Hello Quay, "for sure one day" one way or the other! These things are curable, they're not terminal.
Hi Karen, wow!! A fellow FiLac experimenter / bold explorer like me!!!
Great to hear from you.
As you say, it is a piece of cake Karen and guaranteed no incontinence.
I am on my 8th day post surgery so you are ahead of me.
I am having drainage mostly yellowish/brownish and some greenish pus. To be very honest, I am not too optimistic. My surgeon gave it good chances before the surgery but post surgery he gave me a 50%-50% due to the track not being mature enough (he found that out during the surgery through the reaction of the laser diode, it didn't "stick" accross the whole fistula).
An Italian expert on Filac gives it between 3-8 weeks before the fistula closing so we both are within that range.
I would assume though that an gradual improvement ought to occur prior to having the closure. In my case this has not taken place yet. I am waiting.
I also have a wound because there was a superficial fistula extension (not involving sphincters) that I believe my surgeon cut off. That's why I have a cavity approximately 1 cm deep and 3 cm wide which is healing and draining as well. So I don't know where each part of the draining is originating from.
Let's hope more people who have had either FiLac or VAAFT join the forum to chip in their words of wisdom. I believe we are the only two people in the world who have posted their experience on the web regarding FiLac (in English). I have read two more in German (one success, one failed).
I look forward to your news Karen! I will keep on posting.
I wish you all the best! Dimitri.

nofistulas
New Member


Date Joined Oct 2017
Total Posts : 15
   Posted 11/3/2017 10:15 PM (GMT -7)   
yes dimitri, there's very little info on actual Filac patients - at least I couldn't find much. So your experiences will definitely help. i'm considering it myself so i'm very curious as to yours and karens feedback on the recovery.

It almost sounds like maybe stool is getting into the tract if the drainage is still brownish. Are you having any pain? Is it abscessing? I'm wondering if maybe it would have been better if your doc has sealed the internal opening. who knows.

as far as my failed LIFT, still recovering. honestly didn't think i'd be in this bad of shape even after a failure. I seem to be stabilizing though. I still have a long wait until we try again. i must have been a really bad person in my past life...

Dimitri71
Regular Member


Date Joined Jul 2017
Total Posts : 63
   Posted 11/6/2017 2:16 AM (GMT -7)   
Hi nofistulas, good points, maybe stool is going in. We all get the feeling we were bad people at some point and this is the result of our sins! Maybe rewards will be provided post this life! Or if we are lucky later in this life.
So to update on my situation. I am on day 12 post FiLac surgery.
Drainage has decreased by a good bit (but it was expected since it always does post-surgery). I would say 50% Vs immediately post surgery. Drainage is fairly liquid, a little jelly like in the center, not purulent. It is brownish not greenish now, and it has some particles (black, ash like), most likely the dead tissue burnt by FiLac. My CRS told me I would see these around the 3rd day, but I started seeing them since yesterday.
My wound (extension of the fistula which was curetted / laid open) is slooowly healing. Which is an additional cause of concern obviously.
I am very doubtful but hopeful that at least there will be some some improvement vs prior to the surgery.
When sitting on the wound it hurts a little bit. But other than that I am 100% back into doing sports etc.
I will now update on a weekly basis because progress is slow anyway! All the best!

Post Edited (Dimitri71) : 11/6/2017 2:25:38 AM (GMT-7)


Dimitri71
Regular Member


Date Joined Jul 2017
Total Posts : 63
   Posted 11/14/2017 2:31 AM (GMT -7)   
Hi to all here!
It's been a week since my last post and I am now on my 20th day post surgery. To sum it up: I would say I am doing better overall, however I don't think the fistula will heal...In any case I will meet my CRS next week to have a formal follow up. If it was up to me I would meet my CRS everyday for a short brief (ha-ha), even if I had to pay for the visit (ha-ha) but unfortunately he does not wish to become my therapist as well.
Drainage has somewhat decreased and is improving, but it has not stopped. I would say 50% lower than what it used to be prior to the surgery and more liquid as the wound is healing (it is yellowish, brownish, greenish etc., the whole stuff).
The secondary extension of the fistula seems to be going well VS prior to the surgery. So overall some improvement, more bearable. If I had to make a - wild and not scientific - guess, I would say that the secondary fistula extension (which was cut off) will close while the primary fistula (which was treated by FiLac) will remain open. But that is just a really wild guess.

The other thing I have noted is that I don't see an active pus source (meaning oozing pus) as I could on my previous (seton) surgery where I could see the pus coming out from both the seton hole and the secondary fistula (however my guaze has coloured exudate as I mentioned above).

Overall the surgery has made it more livable (so far). It's too early though to judge the whole thing as there is a wound and it will take time to heal and present the whole picture in a more concise manner.
In terms of sports I am 100%, doing everything that I want. There is some ache in the wound when I seat and move in / out of the car, as well as on the edges of the wound, but gradually decreasing. I will update post my CRS visit. All the best to all co-fistula sufferers and to the people I've come to admire, the Crohn sufferers.

Post Edited (Dimitri71) : 11/14/2017 2:37:23 AM (GMT-7)


nofistulas
New Member


Date Joined Oct 2017
Total Posts : 15
   Posted 11/14/2017 8:56 PM (GMT -7)   
Thanks for the update. crossing my fingers for you. on the one hand i'm curious as to what is causing all the drainage if it's not stool. but on the other, it's good that the fistula has a path to drain. if the external opening healed over, it could get quite painful.

i just got out of surgery again, putting the seton back in after the failed lift. The fight continues....

Dimitri71
Regular Member


Date Joined Jul 2017
Total Posts : 63
   Posted 11/16/2017 1:47 PM (GMT -7)   
Thanks no fistulas.
just a quick update.
I actually went today to see my CRS, he had a spot and as I was eager, I grabbed it.
He said that things look good, and that the secondary track is healing. He gives an 80% chance of success now.
Mind you, prior to the surgery he gave me an 80-90% probability for success. Right after the surgery he gave me a 50% (I describe above his rationale) and now when I asked him if it is still 50%-50% he said "no it is significantly more". I pushed him about the percentage and he said 80%. But he said it will take two months to heal....
Really, I wish I could believe him.
In any case, drainage has further subsided (to about 20% of the original amount) during the last two days and it is very light yellow now. He said it is not puss just serum and reconstructive liquids. I wish I could believe that as wellsmile.
I give myself a max 50%-50% with better chances for the external secondary fistula which is supeficial (which looks good now).
God bless and keep strong to all. What does not kill us makes as stronger... especially chronnies, who I admire like nobody else...you are in my heart...I think this disease is making me a lot better as person and more sensitive to the other's pain. God bless for that, that's a great gift in in life, even if its fairly late (I'm 46). I've been a prick and many times insensitive to what others go through and if a fistula is what made me realize this, then I embrace it! Sorry for rambling.

jasontch
New Member


Date Joined Nov 2017
Total Posts : 1
   Posted 11/21/2017 11:37 PM (GMT -7)   
hi dimitri, thank for your update! May I know you are in how many day of post surgery now?

Post Edited (jasontch) : 11/22/2017 1:05:58 AM (GMT-7)

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