Surgery for Anal Fistula

Anal fistula surgery is a procedure to treat an abnormal connection between the inside of the anus and the skin around it, known as an anal fistula. The goal of the surgery is to close the fistula and prevent further infection and discomfort.

Types of Surgery for Anal Fistula

• Fistulotomy: This is a surgical procedure where the doctor cuts open the fistula to allow it to heal from the bottom up. It's usually performed under general anesthesia or local anesthesia with sedation.
• Seton placement: A seton is a thin, flexible tube made of rubber or silicone that is inserted into the fistula to keep it open and allow it to drain. The seton is left in place for several weeks to allow the fistula to heal.
• Fistulectomy: This involves surgically removing the entire fistula tract, including any infected tissue. It's usually performed under general anesthesia or local anesthesia with sedation.
• Advancement flap procedure: This is a surgical procedure where a flap of skin and tissue is moved over the fistula to cover it and promote healing.
• Ligation of intersphincteric fistula tract (LIFT) procedure: This is a minimally invasive procedure that involves ligating (tying off) the fistula tract with sutures or clips, rather than cutting it open.
• Video-assisted anal fistula treatment (VAFT): This is a minimally invasive procedure that uses a small camera and surgical instruments to treat the fistula.

Risks and Complications of Anal Fistula Surgery

• Infection: As with any surgery, there's a risk of infection after anal fistula surgery.
• Bleeding: There may be some bleeding during or after the procedure.
• Pain: Patients may experience pain or discomfort after the procedure, which can be managed with medication.
• Fecal incontinence: In rare cases, anal fistula surgery can cause fecal incontinence (loss of control over bowel movements).
• Recurrence: There's a risk that the fistula may come back after surgery.

Preparation for Anal Fistula Surgery

• Patients should stop taking any medications that may increase the risk of bleeding, such as aspirin or ibuprofen, before the procedure.
• Patients should also inform their doctor about any medical conditions they have, such as diabetes or high blood pressure.
• The patient will typically be asked to fast for several hours before the procedure.
• An enema or bowel prep may be given to clean out the bowel before surgery.

Recovery After Anal Fistula Surgery

• Patients can usually go home the same day as the procedure, but may need to rest for several days.
• Pain medication will be prescribed to manage discomfort.
• The patient should avoid heavy lifting, bending, or straining for several weeks after surgery.
• A follow-up appointment with the doctor will be scheduled to check on healing and remove any sutures or setons.

Post-Operative Care

• Patients should keep the surgical site clean and dry to promote healing.
• A warm bath or sitz bath can help reduce discomfort and promote healing.
• Avoiding spicy or fatty foods can help reduce irritation to the anal area.
• A high-fiber diet can help prevent constipation, which can put strain on the surgical site.