Member Comments are provided by individuals and reflect their personal opinions only. Under NO circumstances should you act on any advice or opinion posted in this forum.  ALWAYS check with your personal physician before taking any action regarding your health! MedHelp International and our partners, sponsors and affiliates have no obligation to monitor any comments posted on this site, or the content and/or accuracy of such exchanges. MedHelp International does not endorse the views of any user.
Gastroenterology  (Expert Forum)
 | 
4th surgery for Anal fistula, may need 5th. help
This forum is for questions regarding Gastroenterology issues such as Acid Reflux (GERD), Barretts Esophagus, Colitis, Colon/Bowel Disorders, Crohn's Disease, Diverticulitis/Diverticulosis, Digestive Disorders, IBS, Stomach Pain.
Post a Question Back to Forum
MedHelp Member's Question

4th surgery for Anal fistula, may need 5th. help

by Giblett, Jan 04, 2003 12:00AM
I am so over these surgeries.  I just had my 4th surgery for a fistula and this one did not work. The Dr. did an extensive flap repair and stiched the flap over the tract. Went yesterday for follow up.  Infection settled in the flap area and he is talking about a seton placement. This surgery was one week ago. I am getting very depressed as he said the tract is way up in the rectum.  I have had the 4 surgeries in 4 months.  Can ANYONE help me with this or direct me to a web site for me to look at.

I don't want to spend the rest of my life dealing with this. Thank you
Member Comments (52)

by PAJ, Jan 04, 2003 12:00AM
Something for you to consider,

Botulinum Toxin for Anal Fissure



The toxin elaborated by Clostridium botulinum binds to the neuromuscular junction, preventing release of acetylcholine and thereby inducing profound paralysis. Injected locally in appropriate doses, however, this otherwise highly lethal substance has proved quite effective in treating a number of disorders manifested by intense muscle spasm (see "Botulinum Toxin: Potent Poison, Potent Medicine" by Lance L. Simpson).

Chronic anal fissure is a common disorder involving spasm of the internal anal sphincter. The aim of treatment is to reduce the hypertonia, which can be accomplished by lateral internal sphincterotomy. However, that procedure may cause minor but permanent alterations in rectal continence. An alternative approach has been local application of botulinum toxin or nitroglycerin ointment, with a view to effecting a medical sphincterotomy.

Investigators at the Catholic University of Rome have conducted a randomized trial of these medical interventions. Fifty consecutive adult patients with chronic anal fissure were randomly assigned to receive either 20 units of botulinum toxin (as a single injection into the internal anal sphincter) or 0.2% nitroglycerin ointment (as a 6-wk course of twice-daily applications to the anus and anal canal). Patients with acute fissure or in whom fissure was a complication of other medical conditions were excluded.

After two months, the fissure was healed in 24 (96%) of the toxin-treated patients and 15 (60%) of the nitroglycerin recipients (p=.005). Nine treatment failures in the nitroglycerin group and one toxin failure were crossed over to the other therapy, which resulted in healing. There were no complications of botulinum toxin. In contrast, five nitroglycerin-treated patients complained of headaches.

Brisinda G et al: A comparison of injections of botulinum toxin and topical nitroglycerin ointment for the treatment of chronic anal fissure. N Engl J Med 341:65, 1999; Hallett M: One man's poison--clinical application of botulinum toxin (editorial). Ibid:118

COMMENT: The U.S. Food and Drug Administration has approved botulinum toxin A for treatment of strabismus, blepharospasm, and hemifacial spasm. In these conditions, the injections must be repeated because their effects wear off within months. The nice thing about botulinum therapy of chronic anal fissure is that complete healing occurs after only one injection. In this vulnerable area, that sits better with me than even minor surgery.



by kimbacat, Jan 04, 2003 12:00AM
To: Giblett
I am really sorry to hear this.  did you have a seton placed before?  were the other surgeries fistulotomies?  was infection or re-abscessing the reason for recurrance?  did they culture each infection?  I think I remember you saying that they ruled out Crohn's disease, right?  with 4 surgeries in 4 months, I think I'd go with the seton to give the area time to heal and sort things out.  I'm guessing that you've been on anti-biotics the whole time and are doing sitz baths and using stool softeners.  the sitz baths are what helped ease the pain the most for me.  oh, and if you don't have any packing anymore, but still need to cover the external opening because of drainage, I found the non-stick gauze pads to be gentler than regular guaze or pantiliners.  there are more extensive surgeries that can be done, using thigh muscles, etc.  



the fibrin glue results have been pretty good, I hear.  results of usage were reported recently.  you might want to check out the american society of colorectal surgeons at fascrs.org  I'd bet they have a summary of the info, maybe from thier annual meeting.  



best of luck to you

by Giblett, Jan 04, 2003 12:00AM
No, I have not had a seton placed, or a fistulectomy, or fistulotomy.  Mine started with an abcess.  Then one doctor went in to tear away some muscle.  In the meantime, I sought a second opinion by a colorectal specialist. 4 weeks after the second surgery, I had emergency surgery because I started bleeding and my white count was 18. He also put in a drain tube.  That stayed in for 2 months. Had another surgery last Friday to remove the tube and he did a large advancement flap.  Stayed in the hospital another 3 days on I.V. antibiotics.  Yes, I have been on antibiotics for some time now. Tequin. So, after my visit this friday, he said I had an infection, opened up where the drain tube was, again,and said he still saw the fistula tract. I go back Monday to get rechecked.  Possible Seton placed. Now you see why I am so depressed.  Nothing has worked.  He has talked about the glue, but I don't know what is next.  Will I ever get over this. And if I have the fistulectomy, he said I might risk being incontinent.  This is the worse case he has ever seen.  I am just wondering if the first doctor messed up and did not know what he was doing.  He should have helped me when he drained the cyst.  Right?

by kimbacat, Jan 05, 2003 12:00AM
To: Giblett
fistulas are unbelievable scarey things.  I'm really sorry you are having problems resolving yours.  it sounds like so far, you've had procedures done to incise and drain the abscess and then most recently had a flap repair done.  getting the abscess incised and drained was the right thing to do.  but there is always the risk of fistula development.  incontinence can be a result of a fistulectomy.  a lot depends on how much of the spincter muscle is damaged or scarred by the infection and healing process.  in some situations, a ceton can result in incontinence too.  but a ceton might help you until your infection is throroughly resolved.  because nothing is going to heal well if you keep getting infections.  



if your surgeon is saying this is the worst he's seen, you might want to consider finding another surgeon that has more experience with fistula repair.  is there a large teaching hospital in your area?  or a colorectal surgeon that 'specializes' in perianal Crohn's disease?  those would be your best bet because they would be the ones that have seen and dealt with a lot of complicated fistulas.



good luck, I hope the doc sees some positive changes at your visit tomorrow.

by Giblett, Jan 05, 2003 12:00AM
To: kimbacat
Thank you so much for your replies.  I WILL post tomorrow and let you know how my office visit went.  I appreciate you and your concerns.  It helps to know some one cares.  If he states he wants to do surgery AGAIN, I will let you know.  Wish me Luck!

by arlmon, Jan 05, 2003 12:00AM
Two years ago, my daughter had a fissurectomy - they anal muscle was cut. It was done with a local. She suffered so much before she had this procedure done. Not that it wasn't painful after - it was. But it got better after time. She also used nitrogyclerine ointment and this was helpful as well. Are you going to see a colorectal surgeon? That's the only surgeon I would recommend, because they are very experienced in this field. Good luck!