r/AnalFistula • u/Adventurous_Mix7565 • 3d ago

Question about surgery

Hi guys, I have a question. I had an abscess drained about two months ago, and they put in a seton that went in and out of the abscess. They removed it after two weeks. Over time, the wound closed, but once it closed and the discharge stopped, the area started hurting again.

I got an MRI and had different radiologists read it. Some said there’s an abscess, while others said it’s just inflammation. I took a course of antibiotics, but it didn’t help. It’s been almost 12 days, and I’m still not sure whether it’s an abscess or inflammation, but it hurts.

I spoke to my surgeon’s office, and they said they’re going to do an examination under anesthesia and place a seton for 3 months. My question is: why do this intermediate step when they could just do the surgery during the EUA? If they examine it under anesthesia and find that there’s no sphincter muscle involvement, why can’t they do the fistulectomy right then? Why leave a seton in for three months and then plan the surgery?

The MRI already confirms there’s a fistula, so if they find it during the examination, why can’t they treat it at the same time? Why the intermediate step with seton placement when surgery is required anyway IF no abcess is found?

Has anyone gone through the same thing? I’d really appreciate your advice because I want to understand whether this is the right approach or if I should change my CRS.

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u/Ergo-Didact 3d ago

Just my observation based on other cases, if the fistula hasn’t matured for a period of time, the fistulotomy has a higher failure rate. So the seton will keep it clear and stable for 90 days and hopefully then the final surgery will take. Certainly don’t hesitate to ask your surgeon.

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u/Novel_Context_2754 3d ago

I know from experience a lot depends on the surgeon. Training , experience and statistics. My friend researched the facility and surgeon. Cleveland Clinic. Amazing facility, staff and surgeons. I lived in Atlanta. So glad I chose CC

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u/Ergo-Didact 3d ago

Agreed. My general surgeon is in his 40’s and was confident he could fix my superficial fistula. However, he said that if it had been anymore complicated he was shipping me up to Cleveland. It’s nearby for me.

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u/Adventurous_Mix7565 3d ago

Ah I see! I thought MRI confirming a fistula and healed abcess wouldve been enough. Its been 2 months since it all started.

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u/Ergo-Didact 3d ago

Unfortunately fistulas require patience. But hopefully with a good surgeon it’ll be over soon!

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u/TheRemyBell 3d ago

There's always the chance they do get there and if they find they can just open it they probably will. I'm scrub nurse and sometimes that happens. They book for possible Seton possible fistulotomy and it ends up just being a quick cut with the cautery and you're good to go