Surgery is not indicated for true fistulas. If its actual anal gland problems then yes, but surgery has not been shown to be very effective for true fistulas. Cyclosporine and pred are the way to go. You can also use ketoconazole to cut the cyclo dose down and make it cheaper. She should also be on a novel protein diet, if you feed raw this would be mean kangaroo, rabbit, something along those lines. Otherwise should do a prescription diet, if its that or euthanize, then it's silly not do the diet even if it does not meet your standards as far as ingredients go. This is an immune system problem, it's doesn't go away with surgery.
Treatment of Perianal Fistulas
Kyle G.Mathews, DVM, MS, Diplomate ACVS, North Carolina State University
Before the discovery that perianal fistulas could be treated medically, surgical interventions were the only treatments available. These included cryosurgery, electrofulguration, rectal pull-through, and tail amputations. Complications were common and included rectal stricture, recurrence, and fecal incontinence. The cause is unknown, but evidence increasingly suggests that the disorder is immune-mediated.Many of these dogs also have colitis. Current treatment of perianal fistulas involves the use of cyclosporine and adjuvant topical therapies, such as tacrolimus ointment. Cyclosporine therapy is very successful, and the speaker describes his protocol and answers such common questions as, “How do I monitor therapy? What is the proper duration of treatment? What is the underlying etiology/reason why cyclosporine works? Why do some dogs respond to therapy and others not? What other ancillary treatments are effective? What other drugs can be given to inhibit cyclosporine metabolism?”
Last edited by ugavet2012; 08-11-2013 at 09:51 PM.