Fistulectomy

An anal fistula refers to an infection that develops in the skin around the anus. It usually originates in the anal canal leading up to the surface of the skin and creating a visible opening. It commonly occurs when the outlet of the anal glands are blocked and infected with formation of pus leading to small pimple like growth called abscess that grow bigger and painful over time. With an existing bowel disease or piles can cause extreme pain at the time of excretion.

Since it happens in the periphery of the anal region it is often called a perianal fistula. A fistula can develop anywhere between intestine and skin or between the vagina and rectum, but the most common location is around the anus. To treat this specialists suggest a surgical treatment called Fistulectomy.

It is a surgical procedure where a fistulous tract is cut out completely. It has many advantages, the most important of which is the high success rate and effective cure in case of disease.

Although they do not pose a life threat, fistulas can be painful. Here’s what one should look for to know that they have a problem and seek doctor’s help:

Look for any instances of discomfort, itching, and irritation right at the anal outlet area.
It is an infection and has an abscess, so check for big pimple like growths that ooze blood or pus filled discharge.
With any slightest existing stool related problems, constipation, piles etc., the patient can face immense discomfort while passing stools. This poses a great risk of developing potentially widespread or systemic infections.
Look for a visible opening around the anal region that might have developed recently which is also painful.
Check for severe reddening of the affected area, that has blood and an abnormal discharge.
One or more of these symptoms require patients to seek surgical intervention.

Anyone can get Fistula. But not everyone can get fistulectomy done. Fistula typically occurs as a consequence of a perianal abscess. It can be treated in two ways.

Fistulectomy: This is for complex and painful fistula which involves a more permanent cure with minimal risk of recurrence.
Fistulotomy: This is a simple OPD treatment for simple anal fistulae with a very high risk of recurrence unless treated with absolute care
Patient’s with a medical history of any of the following less common factors are also at a high risk of a complex fistula calling for a thorough Fistulectomy:

Crohn’s disease (an inflammatory disease of the intestine),
Radiation (treatment for cancer),
Trauma,
Sexually transmitted diseases,
Tuberculosis,
Diverticulitis (a disease in which small pouches form in the large intestine and become inflamed) and
Cancer growing into an area (usually in the pelvic area) of the body.

Fistulectomy is the preferred treatment recommended for patients with an anal fistula, also medically known as fistula-in-ano. Delay in treatment of fistula can lead to

Repeated attacks of pain and discharge
Increase in complexity of fistula.
Higher chances of failure of definitive surgical treatment.

A fistulectomy is one of several treatment methods used to resolve fistulas. Patients who undergo the procedure have a higher chance of permanently recovering from their condition, as opposed to the use of a drainage seton, fistula plug, or fistulotomy. The procedure is also expected to completely resolve associated symptoms including chronic diarrhea and incontinence.

Here is how a fistulectomy is done:

Patients are advised to first undergo a diagnostic procedure to properly identify and classify the problem. Fistulas are diagnosed through an outpatient physical examination called EUA or Examination under Anesthesia, which usually takes the form of an anoscopy.
The Doctor first identifies the three key parts of the fistula – external and internal openings and the tract and looks for common signs of fistula and classifies the problem based on location and impact. This is called the Park’s classification.
Location wise: low-level fistula (lower anal region) , high-level fistula (pelvi-rectal region)
Impact wise: intersphincteric, transphincteric, suprasphincteric or extrasphincteric.
Process is performed under general or spinal anesthesia.
Depending on the complication level, the surgeon may inject a contrast dye into the fistula’s external opening and identify all the part of the fistula with help of an imaging tool.
The surgeon may then proceed to remove all three parts of the fistula keeping the sphincter muscle intact.
The entire procedure takes only 45 minutes to an hour while patients often take 4 to 6 weeks to heal completely.

The procedure/ surgery take approximately 45-60 minutes.

You should rest for the first few days and on an 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.

Immediately after surgery you may be advised to intake clear liquids only for 24 hours to minimise nausea and constipation. You will then be able to progress to a regular diet.

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