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Hi there,

Let me preface by saying I am in Germany working and moving home this summer.  I was diagnosed with Crohns in Germany a few months ago.  I have had a fistula for about 2-3 years.  I have been on cortisone before and the fistula healed for a short time and then came back.  I have been on antibiotics and same thing.  Right now I have gone through MRI's and tests.  A surgeon in the states just looked at it and suggested a larger surgery(s).  The surgeon here in Germany suggested trying a glue like biologic substance to try to fill it but it only has a 20% success rate and then surgery.  My gastro told me to keep taking my prednisone.  I have been on it since diagnosed with some yucky side effects.  It has helped with the draining and inflamation but I had a test that upset the fistula about two weeks ago and it is just now starting to heal again.  The gastro wants to try Humira after this or Remicade.  I am going to be at home in the US for a short time and will get another opinion from a specialist.  When is the time to get surgery and not?  I seem to have differnet opinions from everyone.  Thanks for your help.  This situation is depressing and confusing.  Anyone had perianal fistula surgery?  What made you decide to do it?  I am just confused.

 Reply posted for Satieheart26.

Just to add my son's exp...

He just had surg. for his fistula, which presented near his coccyx, was causing increasing pain, dripped icky mucous and made having a BM quite painful.

The surgeon unroofed this fistula as much as possible and put in a seton, which looks like a red elastic looped from the wound site and through the anus.

My son's post-op pain has been minimal--less pain than he was in before surg.  We are still waiting for that first BM though--it has been two days.

I have had to pack the wound with gauze tape, which is not something we anticipated.  It went ok today, though I know I did not do as well as the wound care nurse who showed me what to do.

The plan is to get the abcess gone and healed before beginning Remicade.  I wish we could have tried Remicade instead of surg., but each case is different and we did what the doctors thought was best.

I have really trying to find out about fistulas and treatment on-line--I really was not prepared  for the wound afterward.

It is so hard to know what is best and I wish that all goes well for you.

 Reply posted for Louann.

I had a perianal fistula 10 years ago when I was diagnosed. My doc avoided steroids and put me on Remicade right away because it also helps with fistulas. It closed up and has never returned. I would avoid surgery. I don't know all the facts but I believe a fistula forms partly because your Crohns blockage is causing the stream to find a new path. Surgery seems like it would just cause further fistulizing. Not an expert though.

 Reply posted for Satieheart26.

I have had a fistula for 2 years. I had a seton to keep things from abcessing in Sept. (Ihad recurrent abseccses) Surgery has been discussed but I am trying Remicade first, beginning Jan 6. I have had surgeries for other complications and believe for me surgery is a last resort. Remicade can heal fistulas (there is research) and with surgery the fistula can reoccur, I suppose it can with Remicade but it makes more sense to me to help the imflammatory condition first, not get cut on.Good Luck! 

 Reply posted for Satieheart26.

I have had surgery (4 times) for perianal abscesses and fistulas.  I may be wrong, but I think that steriods are supposed to be avoided if you have fistulas.  You may look into that because it could be slowing your healing.  Hope this helps!

 Reply posted for Satieheart26.

Satieheart26 -  Check out the following website:

 www.colonrectal.org/patientinfo/conditions/perianabscess.htm

I had the same fistula surgery back in 1969 and have never had any further problem with it.  It was suggested to me that I find a surgeon with experience performing this surgery; but then, one should always seek out the most experienced professional one can find for just about every task we ask someone else to perform for us.  8^)

After things heal, a precess which is not nearly as bad as one might think it would be (I recall that the stool softeners really helped immediately after surgery), you will be as good as new.  Good luck and good health! - Bob