46280 Surgical treatment of anal fistula (fistulectomy/fistulotomy); transsphincteric, suprasphincteric, extrasphincteric or multiple, including placement of seton, when performed

Name of the Procedure:

Surgical treatment of anal fistula (fistulectomy/fistulotomy); transsphincteric, suprasphincteric, extrasphincteric, or multiple, including placement of seton.

Summary

This surgical procedure treats anal fistulas, abnormal connections between the body's internal parts and the skin near the anus. The procedure involves either removing the fistula (fistulectomy) or cutting it open (fistulotomy) and may include placing a seton, a thread-like material to help drain infection and promote healing.

Purpose

The goal is to eliminate the anal fistula, reduce infection, and promote healing. The treatment aims to relieve pain, prevent recurrent infections, and improve the patient's quality of life.

Indications

• Recurrent abscesses or infections around the anus.
• Persistent pain or discharge near the anus.
• Previous attempts to treat the fistula have failed.
• Complex fistulas involving multiple tracts or affecting muscle.

Preparation

• Patients may need to fast for several hours before the procedure.
• Adjustments to medications (especially blood thinners) might be necessary.
• Preoperative imaging or assessments to map out the fistula tracts.

Procedure Description

1. Patient receives anesthesia (general or regional).
2. Surgeon examines the anus and rectum to locate the fistula tracks.
3. Depending on the type of fistula, the surgeon either excises the fistula (fistulectomy) or opens it (fistulotomy).
4. A seton may be placed for complex or high fistulas to aid drainage.
5. The surgical site is then cleaned and may be left open to heal or sutured closed.

Duration

The procedure typically lasts between 30 minutes to 2 hours, depending on the complexity of the fistula.

Setting

This surgery is usually performed in a hospital or outpatient surgical center.

Personnel

• Colorectal surgeon or general surgeon
• Anesthesiologist or nurse anesthetist
• Surgical nurses and assistants

Risks and Complications

• Infection
• Bleeding
• Fecal incontinence
• Recurrence of the fistula
• Pain and discomfort

Benefits

• Relief from pain and discomfort.
• Resolution or significant reduction in infections.
• Improved anal function and quality of life.
• Healing typically begins soon after surgery, with benefits realized as the site heals.

Recovery

• Patients should follow post-procedure care instructions, including wound care and Sitz baths.
• Pain management medications may be prescribed.
• Avoid strenuous activities for about 2-4 weeks.
• Follow-up appointments to monitor healing.

Alternatives

• Non-surgical options like antibiotics and drainage.
• Fibrin glue or plugs to seal the fistula.
• Pros: Less invasive, quicker recovery.
• Cons: Lower success rates compared to surgery for complex cases.

Patient Experience

During the procedure, patients will be under anesthesia, so they should not feel anything. Post-procedure, there may be discomfort and pain, which can be managed with medication. Patients may experience drainage and need to follow meticulous hygiene practices to aid recovery and prevent infections.