46275 Surgical treatment of anal fistula (fistulectomy/fistulotomy); intersphincteric

Name of the Procedure:

Surgical treatment of anal fistula (fistulectomy/fistulotomy); intersphincteric

Summary

In simple terms, this surgical procedure is used to treat an anal fistula, which is a small tunnel that forms between the skin near the anus and the rectum. The surgery aims to remove or open up the fistula to allow it to heal properly.

Purpose

The main goal of this procedure is to address an anal fistula, which can cause pain, discomfort, and recurring infections. The expected outcome is the resolution of the fistula and an improvement in related symptoms.

Indications

• Persistent anal pain
• Recurrent anal infections or abscesses
• Drainage of pus or blood from an opening near the anus
• Failure of less invasive treatments to resolve the fistula

Preparation

• Patients are usually advised to fast for at least 6-8 hours before the procedure.
• Medication adjustments may be necessary, such as stopping blood thinners.
• Preoperative diagnostic tests might include imaging studies like an MRI or an ultrasound, and an examination under anesthesia.

Procedure Description

1. The patient is placed under regional or general anesthesia.
2. The surgeon makes a small incision in the skin near the fistula.
3. For a fistulotomy, the fistula tract is opened along its length to allow it to heal from the inside out.
4. For a fistulectomy, the entire fistula tract is completely removed.
5. Special tools like probes, scissors, and electrocautery devices are used during the procedure.
6. The surgical site is cleaned and sutured, if necessary, and a dressing is applied.

Duration

The procedure typically takes about 30 to 60 minutes.

Setting

This procedure is commonly performed in a hospital or a specialized outpatient surgical center.

Personnel

• Surgeon
• Anesthesiologist or nurse anesthetist
• Surgical nurses and/or technicians

Risks and Complications

• Infection at the surgical site
• Bleeding
• Incontinence or difficulty controlling bowel movements
• Recurrence of the fistula
• Adverse reactions to anesthesia

Benefits

• Resolution of the fistula
• Relief from pain and discomfort
• Reduced risk of infection
• Improved quality of life
• Most patients experience significant improvement within a few weeks after the procedure.

Recovery

• Post-procedure care includes keeping the surgical site clean and dry.
• Pain management may involve prescribed medications and sitz baths.
• Patients should avoid strenuous activities for a specified period.
• Follow-up visits are often required to monitor healing and remove any stitches.
• Full recovery generally takes a few weeks to a couple of months, depending on the complexity of the fistula.

Alternatives

• Antibiotic treatment (less effective for complex fistulas)
• Seton placement (a thread placed to help drain the fistula)
• Fibrin glue injection
• Advancement flap procedure
• Each alternative has its pros and cons, such as varying success rates and recovery times.

Patient Experience

• During the procedure, the patient is under anesthesia and should not feel pain.
• Post-surgical pain and discomfort are managed with medication.
• Common feelings post-surgery include soreness and a mild burning sensation.
• Patients are encouraged to take it easy and follow aftercare instructions to ensure optimal healing.