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Suffered perianal abcess. Experiencing discharge from the location. Suggested fistula and recommended seton. Natural healing?

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General & Family Physician
Practicing since : 1978
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thank you, i have recently suffered from a perianal abcess and which was lanced under anaesthetic in hospital. this was done about 3 months ago. since then I have experienced discharge from the location and now feel that it has cleared up quite well with no pain. At my recent follow up visit with my surgeon, he has said that I have a fistula and recommends a seton be applied..... I would like to know if this is absolutely necessary as I do not feel pain and am not discharging. I worry that a seton will only open the area up and might be a start of many surgerical procedures.
Am I too worried? Am I thinking right in that I should I follow a natural healing course for a couple of months to check
that there is no problems before going into a surgery for a seton?
Posted Wed, 28 Aug 2013 in Abdominal Pain
Answered by Dr. Pavan Kumar Gupta 1 hour later
Thanks for the query.
I can understand your confusion on this issue.
Since there was a constant drainage from the site for past 3 months,it is clear that a anal fistula has formed.It has temporarily closed because the external opening of anal fistula has closed temporarily.
Your surgeon is definitely right that it requires a treatment,although you are not experiencing any problem with it.
If you don't go for the treatment,you will eventually definitely get pus collection and get anal abscess again causing pain and discharge.This collection of pus may result in systemic infection also.
Since the fistula tract has been formed,it won't heal of its own and so you definitely require a surgical procedure to take care of it.
SETON is a thread which is put in the tract and is left there for few npmonths.
It helps in natural drainage,clearing of pus collection and formation of fibrous tissue.
At a later date ,once the drainage is complete ,then this fistula tract can be laid open and your problem rectified.
SETON is a simple procedure and there is nothing to worry for this.
You must go for it.
I hope it helps however you may revert to me for any further query.
Best of luck
Above answer was peer-reviewed by
Follow-up: Suffered perianal abcess. Experiencing discharge from the location. Suggested fistula and recommended seton. Natural healing? 16 minutes later
thank you Dr XXXXXXX OK your advise is quite firm and convincing. would like to know what you mean by 'laying fistula tract open'. this sounds like it will require surgery and if so how do I manage Bowel Motions over that time.
Also a couple more questions if I may:
I am intending now to proceed with the seton, but would like to leave it til after an overseas trip in November. Is that too long?
I live in Sydney Australia and was told by an Indian friend of mine about the "Kshar XXXXXXX ayurvedic" treatment for this problem. Do you know anyone in Ausytralia preferably Sydney that I may consult about this?

Answered by Dr. Pavan Kumar Gupta 8 minutes later
Laying the tract open means surgical removal of the tract because this removal of Tract is very important so as ,you don't get it again.
There is no problem in managing your bowel movements,although a slight inconvenience because you would be requiring dressing daily after the bowel movement.
In my opinion ,delaying till after november may not be possible because your opening is closed at the moment and there can be formation and collection of pus anytime.
Very frankly speaking neither I know about the usefulness of this Ayurvedic treatment nor I know anybody in Sydney who may be doing this treatment.
Above answer was peer-reviewed by
Follow-up: Suffered perianal abcess. Experiencing discharge from the location. Suggested fistula and recommended seton. Natural healing? 26 minutes later
Dear Dr Pavin:
If November is not recommended, I have a few more questions in reference to timing of the seton placement and the lay open surgery as I have committed financially to the trip:

1/If the seton is inserted next week say, should I be OK to leave it in till after December?
2/Is the lay open surgery required immediately after removing the seton or can I delay open surgery for a period of time?
3/the fistula I am told is at 3'oclock. will the tract be very deep and how long do you estimate that it will take to heal if there are no complications.

thank you
Answered by Dr. Pavan Kumar Gupta 13 minutes later
1... Yes you can leave it for 3-4 months.
2... You should get operated immediately after removal of seton other wise the purpose of seton is lost.
3... Normally such wounds take 6-8 weeks to heal.Sometimes it may take 10 -12 weeks also.
Above answer was peer-reviewed by
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