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Thread: Fistula plug

  1. #1
    Senior Member vgrafen's Avatar
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    Fistula plug

    My surgeon placed a plug in my fistula yesterday, rather than fillet-ing me open and removing the entire thing.

    SCI-Nurse, what are your experiences with the fistula plug? Have you seen fistulas return after placing the plug? Any complications?

    Have any of you plegics, para and quad, had this procedure? If so, was it successful?
    vgrafen

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  2. #2
    A fistula where? Fistula just means an opening between either two organs or an organ and the outside that does not belong there. It doesn't tell us anything else.

    (KLD)

  3. #3
    Senior Member vgrafen's Avatar
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    SCI-Nurse, the fistula is above the anus and below the coccyx. It empties into the rectum.

    Over the weekend, after the plug was placed, I seemed to get ill, a little feverish and achy. I'm better today; could that have been a reaction to placing the plug?

    I'm on Rifampin for osteomyelitis, and Clindamycin for the strep in my fistula.
    vgrafen

    My book, 'Scouring the globe for a cure: a disabled man's experiences with stem cell treatment' is available at Booklocker at the following address:

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  4. #4
    i had a rectal fistula. was sliced open, packed and allowed to heal.

    ambulatory procedure, epidural used

    they are prone to abcess and if that happens, good luck

  5. #5
    Senior Member vgrafen's Avatar
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    crags, was the rotten 'tube' removed or cleaned? How long did it take to heal? Any complications? Did it return?
    vgrafen

    My book, 'Scouring the globe for a cure: a disabled man's experiences with stem cell treatment' is available at Booklocker at the following address:

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  6. #6
    I am not familiar with plugging fistulas such as this. In my experience this is more likely to lead to abscesses and infections than surgically cleaning it out, as often these tracts are epithelialized (covered with skin cells) and will not close otherwise, and plugging them just traps bacteria. I think you need to talk with the physician who did the plug and better understand their rationale for doing this risk wise vs. surgical intervention.

    (KLD)

  7. #7
    Is the plug a string that they gradually tighten, so that over time the fistula is eventually laid wide open? I've read of that. I was like screw it, break out the scalpel.

    If not, what is the plug to do? Just stop drainage? Why, if it only drains into the rectum? I think it will be like a beaver dam on a pond. They plug the drainage spout, eventually the water erodes the soil around the spout, so you've got a much bigger hole in the dam.

    Did you talk to her about filleting it? It does work.

    They cut a V-shaped wedge the entire length of the fistula, with the pointy end of the V being just below the channel that the fistula created. Leaves a fair-sized canal. They don't stitch it closed. They cut it that shape so it get clean, stays clean, and heals from the inside out. The length of the cut would depend on the length of the fistula. As KLD says, the fistula is a channel of skin cells, much like a mini-rectum. It won't heal for the same reason your rectal walls don't grow together. Those cells aren't meant to form a seal.

    My fistula drained feces and pus from inside the rectum to the outside skin near my tailbone. They outside part would heal, then all the pus etc would build up into a way painful knot and eventually burst. Antibiotics cleared it up temporarily until the knot started developing again. I don't see how a fistula can drain to inside the rectum. It is created by nastiness (usually from an initial rectal abscess) trying to get out. I've heard of them forming from rectum to vagina I don't get how one would form that went from the outside inwards, if that makes sense.

    Get it cut, V. In 6 weeks it's over. I've had 1 fissure in the past 6 years, since that surgery. 1 week of flixoril suppositories healed that right up. Have you talked to them about trying rectal nitroglycerine paste? I can't use it but it is said to be effective.
    Last edited by betheny; 10-28-2008 at 01:56 AM.

  8. #8
    NM, I found the plug method. New treatment, cool! What type did she use?

    "An anal fistula is an abnormal connection between the epithelialised surface of the anal canal and (usually) the perianal skin.

    Anal fistulae originate from the anal glands, which are located between the two layers of the anal sphincters and which drain into the anal canal. If the outlet of these glands becomes blocked, an abscess can form which can eventually point to the skin surface. The tract formed by this process is the fistula.

    Abscesses can recur if the fistula seals over, allowing the accumulation of pus. It then points to the surface again, and the process repeats.

    Anal fistulas per se do not generally harm and they often do not hurt, but they can be irritating because of the pus-drain (and, it is not unknown for formed stools to be passed through the fistula); additionally, recurrent abscesses may lead to significant short term morbidity from pain, and create a nidus for systemic spread of infection.

    Surgery is considered essential in the decompression of acute abscesses; repair of the fistula itself is considered an elective procedure which many patients elect to undertake due to the discomfort and inconvenience associated with a draining tract....

    * Doing nothing - a drainage seton can be left in place long-term to prevent problems. This is the safest option although it does not definitively cure the fistula.

    * Lay-open of fistula-in-ano - this option involves an operation to cut the fistula open. Once the fistula has been layed open it will be packed on a daily basis for a short period of time to ensure that the wound heals from the inside out. This option leaves behind a scar, and depending on the position of the fistula in relation to the sphincter muscle, can cause problems with incontinence. This option is not suitable for fistulas that cross the entire anal sphincter.

    * Cutting seton - if the fistula is in a high position and it passes through a significant portion of the sphincter muscle, a cutting seton may be used. This involves inserting a thin tube through the fistula tract and tieing the ends together outside of the body. The seton is tightened over time, gradually cutting through the sphincter muscle and healing as it goes. This option minimizes scarring but can cause incontinence in a small number of cases, mainly of flatus (wind). Once the fistula tract is in a low enough position it may be layed open to speed up the process, or the seton can remain in place until the fistula is completely cured.

    * Fibrin glue injection is a method explored in recent years, with variable success. It involves injecting the fistula with a biodegradable glue which should, in theory, close the fistula from the inside out, and let it heal naturally. This method is perhaps best tried before all others since, if successful, it avoids the risk of incontinence, and creates minimal stress for the patient.
    * Fistula plug is an "advanced" version of the fibrin glue method. It involves "plugging" the fistula with a "plug" made of porcine small intestine submucosa (sterile, biodegradable), fixing the plug from the inside of the anus with suture, and, again, letting the fistula heal "naturally" from the inside out. According to some sources, the success rate with this method is as high as 80%.
    * Endorectal advancement flap is a procedure in which the internal opening of the fistula is identified and a flap of mucosal tissue is cut around the opening. The flap is lifted to expose the fistula, which is then cleaned and the internal opening is sewn shut. After cutting the end of the flap on which the internal opening was, the flap is pulled down over the sewn internal opening and sutured in place. The external opening is cleaned and sutured. Success rates are variable and high recurrence rates are directly related to previous attempts to correct the fistula.
    * Anal Fistula Plug is a recently developed method known as AFP. This treatment requires placement and fixing of a plug in the anal fistula by a special technique. The plug is made of highly sophisticated absorbent material; it provides a scaffold over which body’s collagen gets deposited and closes the fistula. Comparative studies have shown this method to be very effective. One advantage of this method is that it involves no cutting, so there is no post operative wound and pain. AFP plugs can sometimes be inserted under local anesthesia. This method can be used successfully to treat high fistula without colostomy. It does not carry any risk of bowel incontinence. As opposed to the staged operations, which may require multiple hospitalizations, AFP requires hospitalization for only about 24 hours. The success rate of AFP is better than the other procedures. AFP was approved for clinical use by the FDA in May 2005 and hundreds of procedures have been done since then. Research has shown that the addition of a transanal advancement flap to the procedure may improve success rates..."

    http://en.wikipedia.org/wiki/Anal_fistula

  9. #9
    Senior Member vgrafen's Avatar
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    SCI Nurse, my surgeon went with the plug over surgery so I wouldn't have to deal with 2 wounds in the same area, as I still have my wound form MRSA, etc. I'm seeing him tomorrow, so I'll ask again for rationale.

    betheny, thanks for your excellent input here. Yes, it was an AFP, and he felt it would be a better fix for me than surgery. I think my body's been reacting negatively to it since, as I've been ill-ish and feverish, though not horribly so.

    I am also seeing Hafner tomorrow to give the go-ahead on flap surgery. Yes, I have relented, after over a year of alternative therapies and traditional treatments has failed to show any real progress. I'm pressing for ASAP, though I'm not looking forward to the down time.

    Looks like I'll now be turning my attention to all things flap-related.
    vgrafen

    My book, 'Scouring the globe for a cure: a disabled man's experiences with stem cell treatment' is available at Booklocker at the following address:

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