Anal Fistula Fistula-in-ano
Fistulectomy is a surgical procedure where a fistulous tract is excised (cut out) completely. This procedure is done to remove a perianal fistula that can form after someone develops a perianal abscess. The fistula may form 4-6 weeks or even a year after the initial abscess, and about 50 percent of abscesses will develop a fistula.
The Procedure
A fistulectomy is performed on an outpatient basis using a local anaesthetic or a spinal. The surgery takes approximately 45-60 minutes. There are 3 important parts of a fistula to identify prior to or at the beginning of the surgery.
• The external opening, which is usually obvious around the anal opening on the outside.
• The tract, which is the connection between the external and the internal openings.
• The internal opening, which is not always evident until during the surgery. Sometimes a blue dye is injected into the external opening to allow identification of the internal opening at the time of surgery.
The fistulectomy consists of removing or opening the 3 components, which is done by dividing the least amount of sphincter muscle as possible. The location of the internal opening will usually dictate how much of the sphincter muscle will be cut or divided. The further up inside the anal canal or rectum the internal opening is located, the more muscle will have to be incised or cut through, leading to more of a risk of leakage or drainage after the wound has healed.
Once the fistula has been removed, the groove or wound is left open to heal. Some fistulas can be very complicated and may require more than 1 surgery.
Healing Time
The healing process usually takes 4-6 weeks. Pain medication and antibiotics will be given at discharge. There will be several post-op office visits required. Our La Peer doctors use minimally invasive techniques that promote quicker healing and less pain. We welcome you to call our surgical centre to learn what options are available to you.
Diet: Start with clear liquids only today, to prevent nausea and constipations (soup, jell-o, juices, carbonated beverages, popsicles or water). Exception: When taking pain medication.Advance to your regular diet tomorrow. Eat lots of whole grains, green leafy vegetables, and fruits. Avoid dairy products.
Medications: Take medications as ordered by your doctor. If antibiotics were prescribed, be certain to
take them as instructed on the bottle. Take stool softeners as prescribed.
Activity: Rest for the next 24 hours and then resume most normal activity as tolerated.Avoid any heavy lifting or strenuous activity for at least 5 – 7 days.
Dressing: Remove dressing tomorrow. Wear soft gauze or peripad in underwear for drainage control.
Change gauze or pad frequently. You may have a drain in your rectum, do no pull on it; leave it along until your clinic visit.
Bathing: No restrictions It is preferred if you have or use a handheld shower to wash the surgical site or wound.
Miscellaneous: No alcohol or driving for 24 hours or while taking pain medicine.
Do not make any personal or business decisions for 24 hours.
You should have a responsible adult with you for the next 24 hours.
Fistulectomy FAQs
Q: What can I do to promote successful healing?
A: Get plenty of rest, remove/change your gauze or pad frequently, take sitz baths 3 times a day and after bowel movements, and follow your aftercare instructions given by our La Peer doctors.
Q: If I am having symptoms post-operatively, when should I seek medical attention?
A: Call our office if you are experiencing:
• Fever over 101 degrees F
• Pain not relieved by pain meds prescribed
• Blood with bowel movements that is more than occasional spotting
• Inability to urinate
• Persistent nausea or vomiting.
Q: When can I return to my normal activities?
A: You should rest for the first 24 hours and on average most patients can slowly resume normal activities. However, your physician will give you personal instructions on when you can return to your daily activities.
To treat your fistula, our team of trained colorectal surgeons can provide you with surgical and/or non-surgical options that are best for you. By scheduling an appointment at the Fissure & Fistula Center of Excellence, and through individualized care and exams, a course of treatment can be tailor made to meet your medical needs.
