Third Opinion

I had an appointment at Lahey Clinic in Burlington, MA in January. Last week, they called and asked if I could come in today. Perfect timing.

I saw my surgeon last week after I went to Boston. He did not recommend doing the gracilis flap surgery. He said he would CONSIDER it for a last option. He said that he would a similar surgery to the first one he did but he would go up through my vagina and try that way. My surgeon said that he was very interested in what the female surgeon at Lahey Clinic was going to say-he values her opinion greatly.

The female surgeon I met with was very nice. She had a great personality. She said she knew my surgeon and his partners and that she had respect for them and thought highly of them and their work. She went straight to work. She said she already read my chart and looked at my pouch studies. She asked me a few questions and said that she wanted to do an exam herself and see the fistula on camera.

I went into the exam room and the next 10 minutes were horrible. I won't give details but fingers and scopes were going in places I didn't want them to. It was very painful and uncomfortable but I knew it had to be done. After the exam, she spoke with my parents and I about her findings and options for surgery.

She said that she would recommend doing a trans-perineum repair of the rectovaginal fistula. It's hard to explain but she wouldn't enter through the anus or vagina. She would make an incision right on top of the fistula and repair it that way somehow. She said a 1-2 day hospital stay and about 4-6 week recovery. (Not bad). She continued to explain and draw a picture of it. It's hard to explain for others to understand. She was worried that if they did the surgery through the vagina that it would cause scar tissue and issues with sex and pregnancy later on in life. 

She said that this surgery is about a 75% success rate. She said that she would send my surgeon the paperwork and call him to discuss it. She seemed very confident in this surgery and that it would work. Of course, there is a chance it wouldn't. It was nice to hear a female perspective on these surgeries. I called my surgeon and made an appointment to see him after New Years so that we can talk about the next move and see if he does these surgeries often. 

Happy Holidays!

Second Opinion

I went to Boston on Thursday to check out a surgeon at the Brigham and Women's Hospital. He specializes in colorectal surgeries. Other than waiting an hour to see him, the appointment went very well.

He is very friendly and sociable. He read through my thick files and came to the conclusion that he wouldn't have done anything different than what my surgeon here did. That was reassuring to hear. He was able to explain everything I already had done in a way I could better understand.

There was not one thing that he would have done differently to repair the fistula. If I decided to go to him for the next surgery, he explained how he would do it. Or how the plastic surgeon would do it.

He would do a gracilis flap which requires a plastic surgeon to pretty much do the whole surgery. This is where they take muscle from my upper leg and stick it between my anus and vagina to heal the fistula that way. He did an exam on me and felt where the fistula was and agreed that it is pretty small.

He said that the plastic surgeons do one of these surgeries at least once a week if not more. They mostly do it for people who have colon cancer, but it is the same procedure.

He stated that this surgery was about 75% chance that it would work and heal the fistula. If for some reason it didn't work then they could possibly try again later on or I would have to consider having the ileostomy permanent. Not that I want to think about that right now, but it was good to hear all the options and possibilities.

There are some risks associated with doing a gracilis flap, as there is to any surgery. It is worth the risks for me. Now I meet with my surgeon here on Tuesday to see what his take on everything is and what he would do for a Plan B. I will mention what the surgeon in Boston said and figure out how many of these surgeries the plastic surgeons here do. That might be the answer to where I have my next surgery. I would ideally like to stay local but going to Boston is definitely something to consider.