Types of Surgeries

Fistulotomy - Anal Fistula Surgery

Overview

What is an anal fistula? It is a small tunnel connecting an infected abscess inside the anus to the outside skin around the anus. The abscesses are usually formed from anal mucus glands lining the walls of the rectum. Sometimes the glands can get clogged and become infected, leading to an abscess. There is a strong likelihood these abscesses develop into anal fistulas.

While infected mucus glands are the most common cause of anal fistulas, there may be other reasons why they may develop, which is why it is important to see your doctor if you suspect you have one. Other conditions that can cause fistulas include Crohn’s disease (about 25% of people with Crohn’s disease develop fistulas), cancer, radiation (from cancer treatment), sexually transmitted diseases, diverticulitis, and physical trauma.

Why?

A fistula should never be left to heal on its own. Untreated and undrained fistulas can become life-threatening if the infection continues to grow and fester. It can even lead to complications like anal cancer or sepsis.

All surgeries, whether they be big or small, carry risks. For anal fistula surgery, or a fistulotomy, these typically include:

Risks

Risks of Surgery

  • Common complications include nausea, vomiting, urinary retention, sore throat, and headaches.
  • More severe complications include heart attack, stroke, pneumonia, and blood clots.
  • Infection of the surgical site.
  • Excessive bleeding from the anal area.
  • Pooling of the blood in the surgical site (hematoma).
  • Pain, swelling, itchiness or tenderness at the site of incision.
  • Fever.
  • Headaches and drowsiness after the surgery.
  • Inability to control one’s bowel or bladder.
  • Recurrence of fistulas after surgery (long-term).
  • Narrowing (stenosis) of the anal canal.
  • Possibility of a rectal prolapse.

What to expect prior to your surgery

You may need to take antibiotics before surgery. Routine blood work is usually not needed but may be ordered prior to surgery based on the patient's age and the presence of any existing medical problems. Ultrasound or MRI’s may be order to get a better view of the fistula tract. Moreover, further tests may be necessary to determine if the condition is related to Crohn’s disease.

A fistulotomy is a minor kind of surgery, and is done on an outpatient basis (you will be able to go home after the surgery is completed). Before your surgery, a nurse or doctor will plan the site, clean the affected area, and consult with you for any questions you may have. An anoscopy – a tool used to help doctors see inside the anus – may be used to help plan the surgery. Then, they will numb the area using a local anesthetic so that you won’t feel any discomfort during the procedure. General anesthesia is reserved for more severe cases, but may be administered under the recommendation of your surgeon.

The procedure itself can last anywhere between a few minutes to an hour depending on the size of the fissure at the time of surgery. Typically, your doctor will give you a heads up on how long the procedure should last.

The procedure

The primary purpose of a fistulotomy is to remove all the pus and fluids inside the fistula and affected area. Removing infected material will help the fistula heal faster and close the abnormal tunnel.

During the procedure, the surgeon will use a scalpel to cut into the fistula. Slight pressure will be applied to the site and the abscess will be drained. Subsequently, infected tissue surrounding the area will be entirely removed. Your surgeon will then stitch the incision and leave it to heal. In circumstances where the fistula is too large to stitch, the wound will be packed with gauze and be left to heal in the open.

After the procedure

Recovery time for a fistulotomy will vary, but you should feel back to normal within a few weeks. Residual pain may last up to a week after surgery. Be sure to keep the area clean and dry to avoid the possibility of infection. Itchiness or soreness is common, however let your doctor know if you experience swelling or excessive pain.

You will need to arrange for a ride home the day of your surgery and we recommend someone stay with you for the first 24 hours at home. When you leave the facility after surgery, we will want you to go home and rest. Avoid making any other plans on the day of your surgery. Starting the following day, you can increase your activity as you feel up to it.

You will likely be given a prescription for pain medication following your surgery. The recovery nurse will discuss a pain control plan following surgery specific to you and your needs including activities like ice applied over incisions and a medication regimen. Oftentimes we will recommend taking Tylenol and Advil (same as Motrin, Ibuprofen) or Aleve in addition to the narcotic pain medication.

Did you know we have a support group?

Your questions and concerns have most likely been asked and answered in our support group. Moderated by our dietitian's, nurses, and staff. We provide you with reliable patient education and resources to help you throughout this life-changing process.