Is surgery necessary for an anal fistula?
For the complete treatment of the fistula, it is necessary that you undergo surgery. The procedure is usually administered by a colon and rectal specialist at the clinic or any other healthcare facility that has the equipment needed to perform this type of surgery. In case the fistula is not treated, it can be very uncomfortable, especially when having a bowel movement. There are also risks of fecal incontinence.
Other consequences of an untreated fistula are the risk of a foul-smelling discharge that can in turn lead to painful abscesses. As the risk for fecal incontinence increases, there is also the risk that your sphincter muscle could get damaged. In this case, untreated fistulas may trigger the development of secondary openings. As a result, you could be faced with a complicated surgery that will also cause damage to your sphincter and therefore lead to gas and fecal incontinence. Some patients have also been faced with the risk of the rectal abscesses turning malignant with time, although such a risk tends to be very minimal.
It is advisable to undergo surgery as soon as a positive diagnosis has been made. This is because by this time, the tract is less clogged and the surgeon can easily administer the procedure with limited risk of complications developing. On the other hand, waiting for too long before seeking surgical treatment would imply that the tract has become more clogged thereby making it harder to treat safely.
The main surgical procedure for treating fistulas include:
Fistulotomy
In this surgical procedure, your surgeon will usually cut open the fistula along its entire length. The objective of cutting the fistula in this manner is to ensure having a flat scar to promote faster healing. A fistulotomy is regarded as the standard procedure for the surgical treatment of fistulas especially if the fistula in question is located near the skin surface.
Fistula plug
In this procedure, your surgeon blocks the internal opening of the fistula with a plug derived from animal tissues. The risk for infection is very minimal as the plug can withstand infection. Moreover, the plug promotes normal tissue growth in the fistula tract.
Fibrin glue
This form of glue is made using three main ingredients: thrombin, calcium, and fibrinogen. Once your surgeon has injected the fibrin glue into the fistula tract, it triggers the formation of a clot. Thereafter, the fistula is closed and it also promotes the development of healthy tissues.
LIFT
This procedure is an acronym for ligation of the inter-sphincteric fistula tract. The surgeon starts the procedure by making a skin incision. The goal of such an incision is to expose the fistula tracts. Once the tract has been exposed, your surgeon will proceed to tie and divide the fistula tract. Your surgeon may also deem it necessary to conduct a BioLIFT. This is a modification procedure whereby the surgeons place a biological mesh in the fistula tract. The biological mesh heels to avoid the reforming of a fistula. Nonetheless, the surgeons would likely require to make a larger skin incision. A BioLIFT also comes with a higher risk of infection.
Endorectal advancement flap
By conducting an advanced flap procedure, your doctor will be seeking to ensure that the internal opening of the fistula remains covered. He/she begins by removing the fistula’s internal opening. Thereafter, the surgeon removes a small healthy flap from the bowel wall for use in covering the fistula.
Most surgical procedures to treat fistulas are usually administered at an outpatient unit. Therefore, you will most likely go home after a few hours. However, it may be necessary to get administered for a short duration after surgery, especially in case the fistula tunnels were large or deep. Moreover, you might require several operations to treat certain fistulas.
Recovery and post-surgical care
You are likely to make a full recovery from fistula surgery without any major complications.
Recovery after fistula surgery varies based on the kind of procedure you underwent and the level of complexity involved.
Generally, 6 weeks are sufficient to ensure complete healing of most fistula wounds.
The following general advice could be useful in promoting quick and smooth recovery:
- Your surgeons may recommend that you soak the affected area in a sitz bath for at least 1 week following surgery.
- Pain medication such as paracetamol or ibuprofen can be helpful.
- Wash the wound a few times each day. Pat the wound to keep it dry.
- Ensure the wound dressing changes regularly.
With proper treatment and healing of both the fistula and abscess, chances of recurrence are greatly reduced.
Stop your suffering NOW
Don't just jump into a surgery because your doctor is advising you to go for it. Consult our doctors to know if you need a surgery at all. Rest assured, we WON'T recommend you surgery unless it's the last resort.
Final words
An anal fistula is a small tunnel that usually forms between your anal skin and the rear of the bowel. An anal abscess can develop into an anal fistula. Other risk factors influence Crohn’s disease, obesity, and occupations where you have to sit for long hours.
A fistula will usually not get better on its own. While antibiotics can help to treat fistulas, you may have to undergo a surgical procedure to permanently cure the conditions. Most surgical procedures such as fistulotomy can be easily administered at an outpatient clinic. You will most likely go home after the surgery. However, your surgeon may deem it necessary to hold you at the hospital for a few days, especially if the fistula tunnel is too deep or you develop minor compilations during surgery. A sitz bath, pain medications, and laxatives post-surgery can aid in faster recovery.
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