Anal Fistula Surgery

[qrudi]

Hello,everyone.

This it's my first post here,I would like to know has any informations about the surgery for anal fistula.

I had a endoscopy done last week and teh doctor told me that I have two anal fistulas,one low and one high,but the only treatment available here it's fistulectomy,what means I can be left with incontinence problems and also a high rate of recurrence.

after a long search on Google,i read that in Thailand it's a new procedure called LIFT and also the fibrin glue injections,with a rate of success of over 80% and no risk of incontinence.

I already emailed to few hospitals in Thailand,and the one who answer me back ,told me about an estimate cost of betwen 80.000 THB and 120.000 THB.

Does anyone esle has any recomandation or it has been thru this already?I have never been to Thailand,so I dont know exactly what should I expect,but I read here that a lot of people are happy about the treatment what they have done it in Thailand Hospitals.

Any advice it's welcomed.

Thanks

[katana]

Get a 2nd opinion on whether you have one. A friend was initially diagnosed with one, but later they decided it was a misdiagnosis.

Did you get an MRI scan? Since they are buried in the flesh they can be hard to spot, but the scan should be able to track the path.

I think incontinence problems depend on how deep they are. The nearer the surface, the less cutting there is and the fewer problems there are in that respect.

[qrudi]

Get a 2nd opinion on whether you have one. A friend was initially diagnosed with one, but later they decided it was a misdiagnosis.

Did you get an MRI scan? Since they are buried in the flesh they can be hard to spot, but the scan should be able to track the path.

I think incontinence problems depend on how deep they are. The nearer the surface, the less cutting there is and the fewer problems there are in that respect.

Thank you for your reply.I have seen 3 doctors so far,I had an perianal abscess few months ago, the doctor made an incision and drained out,but the pain it's still there...since than I am on anti-inflamatory pills,but now they start to have almost no effect.

The doctor send me to the MRI,but I was scheduled for December 17,and this was like two months ago,and I really can't wait anymore,until they will see the result and after that they have to decide what should I do and all the bureaucracy...

I went to a private clinic two weeks ago and they made a endoscopy and injected some stuff to see where the fistulas are going...anyways,was one of the most painful experience ever,and they ask me to do a colonoscopy ,wich I refuse,because they told me that they do just fistuloctomy at the clinic ,and they never hear about the LIFT procedure..so I think it's better to have a colonoscopy done,by the doctor who will make the surgery..

Looks like they invented this new procedure in Thailand and that's why I decide to go for it..

Waiting for some answers from the people who been thru this..

Thanks

[mommysboy]

Get a 2nd opinion on whether you have one. A friend was initially diagnosed with one, but later they decided it was a misdiagnosis.

Did you get an MRI scan? Since they are buried in the flesh they can be hard to spot, but the scan should be able to track the path.

I think incontinence problems depend on how deep they are. The nearer the surface, the less cutting there is and the fewer problems there are in that respect.

Thank you for your reply.I have seen 3 doctors so far,I had an perianal abscess few months ago, the doctor made an incision and drained out,but the pain it's still there...since than I am on anti-inflamatory pills,but now they start to have almost no effect.

The doctor send me to the MRI,but I was scheduled for December 17,and this was like two months ago,and I really can't wait anymore,until they will see the result and after that they have to decide what should I do and all the bureaucracy...

I went to a private clinic two weeks ago and they made a endoscopy and injected some stuff to see where the fistulas are going...anyways,was one of the most painful experience ever,and they ask me to do a colonoscopy ,wich I refuse,because they told me that they do just fistuloctomy at the clinic ,and they never hear about the LIFT procedure..so I think it's better to have a colonoscopy done,by the doctor who will make the surgery..

Looks like they invented this new procedure in Thailand and that's why I decide to go for it..

Waiting for some answers from the people who been thru this..

Thanks

I had an operation out here in Thailand for a simple fistular in ano. It was painless and successful but I would have preferred a full anaesthetic. I had heard about the glue approach but was not offered it. I think your fear is understandable but would only apply to a very deep fistular where large mass of muscle was involved.

It sounds to me like you need a firm diagnosis first, and there are any number of mid range hospitals in Thailand that can offer that. If in Bangkok try St Louis, Sathorn.

From what I learnt, a fistular can be blind or open (just like a tunnel). A low fistular points usually to a local infection of no great bearing, but a high fistular could, I stress could, point to a bigger problem such as colitis, or immune deficiency.

Either way, you'll need tests prior to the op. and I reckon you should ask for these beforehand as it gets a bit unnerving to have so much done on the day.

There's no great urgency, but you need to get this done sooner rather than later. Quite apart from the immense pain of another boil in such a prone place, there's a greater risk of general sickness if left untreated.

I'm sure one of the mods will give a definitive answer, but for now relax, don't listen to any pain stories, you'll be alright for sure.

[qrudi]

Thank you for your recommendation.Today I made the appointment with St. Louis Hospital,they offer me to make the surgery for an approximate 60.000 THB,since it's almost half of the price of what other hospitals offer me,I think I will go for it.The Bangkok Hospital Pattaya,offer me to make the MRI scan for the cost of 20000 THB,and I think it's quite expensive,so I will see what St. Louis will offer me.

in the last days I am in a huge pain,what goes to the whole left leg,and I can barely walk or sit,even after I take Diclofenac and Ketonal,and I dont know if this it's normal..like I said,any suggestions are welcome.

[hhgz]

You've visited many hospitals, spoken to several doctors, received differing estimates for the cost of treatment, and have gotten a few comments about personal experiences and recommendations. Exactly what are you looking for before you decide to have the surgery?

Edited November 27, 2009 by hhgz

[mommysboy]

You've visited many hospitals, spoken to several doctors, received differing estimates for the cost of treatment, and have gotten a few comments about personal experiences and recommendations. Exactly what are you looking for before you decide to have the surgery?

Yes I think it would help if a the poster could keep posting since one of his/her main concerns about incontinence hasn't been answered. And I hope a mod can post soon. That aside I know St Louis is a good hospital and it is recommended time and time again, and this is a standard medical procedure with a very high succes rate. I understand the OP's state of mind and he/she is probably suffering from quite extreme pain caused at this moment caused by the swelling in the area which may have caused a temporary external pile. It really can be distressing and I speak from experience.

[qrudi]

Sorry for not beeing more specific on my intentions..I am still in Europe,I have not been to any hospital in Thailand yet..I am 31 years old male,I dont want to deal with this for the rest of my life..I hear stories about people who have been to 4-5 operations for a fistula,because the fistula have a high rate of recurrence ,but from what I have read so far it's mostly because not all the surgeon doctors are aware of the new methods of treatment.

The doctors to whom I've been so far,one made a endoscopy,and he told me that I have to go for a colonoscopy,and after that I should do a test with barium ,to see the trajectory of the fistula..The second one,he wanted me to go next day to the surgery,based on the fact that he will see the trajectory when he will make the operation..I just walk away..and the third one (my GP),check me (jsut with his finger,wich caused a terrible bleeding) and he said that I may have just hemhorroids..and he send me to make an appointment for MRI,and based on that result,I should return to him, and he would send me if it's necesary to a specialist..the only thing it's that I was scheduled for the MRI scan for 17th of December,and I belive that I will not see a surgeon till next year.

So,what do I need at the moment it's a colon specialist surgeon,who can make a colonoscopy or a MRI,and give me a right diagnostic and see what kind of surgery it's the best in my situation,and have the operation done.

so,I decide that I will fly to Thailand next week,and talk to the surgeon there,they recommend me Dr.Terasun Tuntitemit,but there are no files in English,on the internet about him..

[LaoPo]

Sorry for not beeing more specific on my intentions..I am still in Europe,I have not been to any hospital in Thailand yet..I am 31 years old male,I dont want to deal with this for the rest of my life..I hear stories about people who have been to 4-5 operations for a fistula,because the fistula have a high rate of recurrence ,but from what I have read so far it's mostly because not all the surgeon doctors are aware of the new methods of treatment.

The doctors to whom I've been so far,one made a endoscopy,and he told me that I have to go for a colonoscopy,and after that I should do a test with barium ,to see the trajectory of the fistula..The second one,he wanted me to go next day to the surgery,based on the fact that he will see the trajectory when he will make the operation..I just walk away..and the third one (my GP),check me (jsut with his finger,wich caused a terrible bleeding) and he said that I may have just hemhorroids..and he send me to make an appointment for MRI,and based on that result,I should return to him, and he would send me if it's necesary to a specialist..the only thing it's that I was scheduled for the MRI scan for 17th of December,and I belive that I will not see a surgeon till next year.

So,what do I need at the moment it's a colon specialist surgeon,who can make a colonoscopy or a MRI,and give me a right diagnostic and see what kind of surgery it's the best in my situation,and have the operation done.

so,I decide that I will fly to Thailand next week,and talk to the surgeon there,they recommend me Dr.Terasun Tuntitemit,but there are no files in English,on the internet about him..

You're talking about an Endoscopy and Colonoscopy which, in your case (colon), are basically the same.

I really don't understand why you would come all the way to Thailand when you're in Europe to have treatment for *fistula's; you could end up in a very costly circus, once you're in a Thai hospital; BEWARE !

I don't know where in Europe you are but the specialists in the EU are well trained in treatment of colon/anal related problems.

I just had (2 days ago) a endoscopy/colonoscopy by a well trained 40 yr old (colon) surgeon-specialist and this was my 4th one.

I belong to the smal percentage of people who suffer from extreme pain during an Endoscopy/Colonoscopy but this time it was less than usual due to a stronger sedation and added painkiller. (My problem is with the large intestine and diverticulitis for which I was hospitalized 4 times in 18 months..)

I strongly suggest you think twice before you think Thailand is heaven in your colon/anal related health-case.

IF they need to operate you...... be prepared for a large bill from the hospital and most hospitals ask for prepayment!

In your case I would put great pressure to the specialist and ask/demand for an urgent Colonoscopy MRI or even a Virtual Colonoscopy; more urgent than the one appointment already made for December 17th; your local home doctor can also put pressure to have the appointment earlier than planned.

Q: Why aren't you insured in the EU?; but if you are, is the insurance company willing to pay for your bills in Thailand ?

Note:

* I find it a bit odd that the specialist have different opinions but maybe the last one is correct and you're suffering from internal hemorrhoids instead anal fistulas.

LaoPo

[qrudi]

from what i've been told in case of endoscopy the camera goes only 10-15 cm inside of the colon,and in the case of the colonoscopy the doctor can see all the colon.I've done only the first one.

In case of the hemorrhoids it's just bleeding and pain,but in case of the fistula's first it's an abscess (wich i have already been thru) and after that sometimes a fistula develops..In my case the doctor who did the endoscopy saw a low fistula and he saw the tract of the fistula with the injection what he made,and he saw another one much high,but he could not see the whole tract,because was to high,he told me.

I live in a small island betwen UK and France,and here it's only one hospital,and they do not have a doctor specialist in colon surgery in the hospital,and they dont pay for the surgery what it's made outside of the island..the doctor told me, that in my case I can have a surgery done by any surgeon..and that's why I think are so many cases of recurrence..

I dont think that Thailand it's a heaven for going to treatment,but if you read a bit about new methods of treatment,the doctors who invented the LIFT procedure it's in Thailand,and he is Thai..and in Europe it's still a experimental procedure.

I asked few clinics in East of Europe (where it supposed to be cheaper), and they ask me 1100 Euro,just for the fistuloctomy,not counting the consultation and colonoscopy cost,and the price at St. Louis hospital it's almost the same,with one day in hospital and all the consultation.

Regarding the endless circus from Thailand,that's one of the reasons why i post here,that maybe somebody who's been already thru this process,will give me some advice whit what should I do and what should i dont...

Regards

Rudi

[LaoPo]

from what i've been told in case of endoscopy the camera goes only 10-15 cm inside of the colon,and in the case of the colonoscopy the doctor can see all the colon.I've done only the first one.

In case of the hemorrhoids it's just bleeding and pain,but in case of the fistula's first it's an abscess (wich i have already been thru) and after that sometimes a fistula develops..In my case the doctor who did the endoscopy saw a low fistula and he saw the tract of the fistula with the injection what he made,and he saw another one much high,but he could not see the whole tract,because was to high,he told me.

I live in a small island betwen UK and France,and here it's only one hospital,and they do not have a doctor specialist in colon surgery in the hospital,and they dont pay for the surgery what it's made outside of the island..the doctor told me, that in my case I can have a surgery done by any surgeon

..and that's why I think are so many cases of recurrence..

I dont think that Thailand it's a heaven for going to treatment,but if you read a bit about new methods of treatment,the doctors who invented the LIFT procedure it's in Thailand,and he is Thai..and in Europe it's still a experimental procedure.

I asked few clinics in East of Europe (where it supposed to be cheaper), and they ask me 1100 Euro,just for the fistuloctomy,not counting the consultation and colonoscopy cost,and the price at St. Louis hospital it's almost the same,with one day in hospital and all the consultation.

Regarding the endless circus from Thailand,that's one of the reasons why i post here,that maybe somebody who's been already thru this process,will give me some advice whit what should I do and what should i dont...

Regards

Rudi

Hmmm,...strange insurance company you have who do not pay for a special colon/anal operation that can't be done in your own island hospital; but I wouldn't believe your doctor also, saying that any surgeon could do such an operation.

In your shoes I would most certainly talk to my insurance company or agent and threaten them to talk to the newspapers and publish about their malpractice of not paying for an operation which can NOT be done in your local hospital !

What about a complicated heart surgery ? They don't pay for that also and let the patient die on your island ?

LaoPo

[Sheryl]

LaoPao, I believe the issue is that the surgery can be done there, but the OP wants to have a different procedure done which is still considered experimental in Europe. He is concerned about the problems with continence that sometimes occur after conventional treatment.

Grudi, before coming I would suggest you go ahead and have the tests recommended by the 1st doctor (assuming they won't cost you anything) and bring the results with you, may save some costs and will certainly facilitate doctor's assessments of your treatment options. As you are (understandably) worried about long term effects of surgery and want to know exactly the risks before hand, it is important that the surgeon have as much information as possible at his disposal when talking with you.

The risks of incontinence etc post- fistulectomy do vary with the location and extent of the fistula.

The LIFT procedure is not suitable and/or preferrable for all fistulas. A lot depends on exact location of the fistula tract relative to the sphincter.

Dr. Teerasan trained at the Mayo Clinic in the US. and thus seems very well qualified in colo-rectal surgery in general How much experience he has had specifically with the LIFT procedure is one of the things you should ask him.

If you are going to come all the way to Thailand for this you should make an effort to be sure to get the best treatment that is available here. I suggest you see more than one doctor. The doctors who pionerred the LIFT approach are the following, all associated with Chulalonghorn University Hospital:

Dr. Jirawat Pattana-arunn, Dr. Arun Rojanaskul, Dr. Chucheep Sahakitrungruang and Dr. Kasaya Tantiphlachiva.

Having come all the way to Thailand out of interest in this specific procedure, you really should try to consult at least one of them. They have private practice hours at Bumrungrad Hospital, that is an expensive place but not bad for just a consultation and as these are the foremost experts in the LIFT procedure I suggest you at least get on of their opinions on your case. If you are a good candidate for LIFT it might be possible to arrange to perfrom it at Chulalonghorn which would be substantially less expensive than Bumrungrad.

(I don't suggest you trying to go directly to Chulalonghorn Hosp to meet these doctors to begin with because government hospitals are very difficult for a foreigner new to Thailand and not speaking Thai to try to navigate through.)

[LaoPo]

LaoPao, I believe the issue is that the surgery can be done there, but the OP wants to have a different procedure done which is still considered experimental in Europe. He is concerned about the problems with continence that sometimes occur after conventional treatment.

Grudi, before coming I would suggest you go ahead and have the tests recommended by the 1st doctor (assuming they won't cost you anything) and bring the results with you, may save some costs and will certainly facilitate doctor's assessments of your treatment options. As you are (understandably) worried about long term effects of surgery and want to know exactly the risks before hand, it is important that the surgeon have as much information as possible at his disposal when talking with you.

The risks of incontinence etc post- fistulectomy do vary with the location and extent of the fistula.

The LIFT procedure is not suitable and/or preferrable for all fistulas. A lot depends on exact location of the fistula tract relative to the sphincter.

Dr. Teerasan trained at the Mayo Clinic in the US. and thus seems very well qualified in colo-rectal surgery in general How much experience he has had specifically with the LIFT procedure is one of the things you should ask him.

If you are going to come all the way to Thailand for this you should make an effort to be sure to get the best treatment that is available here. I suggest you see more than one doctor. The doctors who pionerred the LIFT approach are the following, all associated with Chulalonghorn University Hospital:

Dr. Jirawat Pattana-arunn, Dr. Arun Rojanaskul, Dr. Chucheep Sahakitrungruang and Dr. Kasaya Tantiphlachiva.

Having come all the way to Thailand out of interest in this specific procedure, you really should try to consult at least one of them. They have private practice hours at Bumrungrad Hospital, that is an expensive place but not bad for just a consultation and as these are the foremost experts in the LIFT procedure I suggest you at least get on of their opinions on your case. If you are a good candidate for LIFT it might be possible to arrange to perfrom it at Chulalonghorn which would be substantially less expensive than Bumrungrad.

(I don't suggest you trying to go directly to Chulalonghorn Hosp to meet these doctors to begin with because government hospitals are very difficult for a foreigner new to Thailand and not speaking Thai to try to navigate through.)

Thank you for joining the discussion Sheryl; most appreciated, and I think the OP will, most certainly, learn a lot from your message.

That doesn't mean he shouldn't talk to his insurance company as I find it unbelievable that they are not prepared to pay for an operation which, in fact, is not possible in the hospital on his small island.

That would be a scandal; an insurance company that degrades inhabitants of an island as 2nd hand clients/patients....

LaoPo

[qrudi]

Thank you very much for the advices..LaoPo,my insurance it's from National Health Insurance,and it's mandatory for every person who works on the island,and you may not belive it ,but it is a lot of discrimination from the local government,betwen the people born on the island and the people who emigrated in to the island(my case)...But anyways,this it's another story,maybe if I would have bought a private insurance,it would be different,but now it's too late. Sheryl,I think you are right,I would follow your advice,now I will go and ask for a colonoscopy done,so I can be more precise about my problems,when I will see the doctors in Thailand..

Thank you very much again,to all of you,for the answers and advices.

[LaoPo]

^^^^

Wish you good luck and if possible, ask for a narcosis/anaesthetic; if not possible (they couldn't/wouldn't do it in my hospital), ask for an extra doses of sedation, combined with a painkiller!

LaoPo

[endure]

^^^^

Wish you good luck and if possible, ask for a narcosis/anaesthetic; if not possible (they couldn't/wouldn't do it in my hospital), ask for an extra doses of sedation, combined with a painkiller!

LaoPo

Pethidine and Midozalam works a treat.