46270 Surgical treatment of anal fistula (fistulectomy/fistulotomy); subcutaneous

Name of the Procedure:

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

Summary

This procedure involves surgically removing or opening an abnormal connection (fistula) between the anus and the skin. The goal is to eliminate the fistula tract and prevent infections.

Purpose

• Medical Condition: Anal fistula, an abnormal channel from the anus to the skin surface.
• Goals: To remove or open the fistula to heal the infection, alleviate pain, and prevent recurrent abscess formation.

Indications

• Recurrent anal abscesses
• Persistent anal pain and discharge
• Swelling near the anus
• Patients with Crohn's disease or other underlying conditions causing fistula formation

Preparation

• Pre-Procedure Instructions: Fast for 6-8 hours before the procedure; adjust medications as directed by your doctor.
• Diagnostic Tests: Preoperative imaging like an MRI or an anorectal ultrasound may be required.

Procedure Description

1. Sedation/Anesthesia: Administered either general or regional anesthesia.
2. Incision: A small incision is made in the skin near the fistula.
3. Fistulotomy: The fistula tract is opened, cleaned, and left to heal from the inside out, or
4. Fistulectomy: The fistula tract is completely excised.
5. Closure: Sometimes sutures or other methods may be used to close the skin.

Duration

The procedure typically takes 30-60 minutes, depending on the complexity.

Setting

Performed in a hospital or outpatient surgical center.

Personnel

• Surgeon: Performs the operation.
• Anesthesiologist: Manages anesthesia.
• Nurses: Assist before, during, and after the surgery.

Risks and Complications

• Common Risks: Infection, bleeding, pain
• Rare Risks: Incontinence, recurrence of the fistula, adverse reactions to anesthesia

Benefits

• Effective resolution of anal fistula
• Alleviation of pain and discomfort
• Reduced risk of recurrent infections
• Benefits are typically realized within weeks post-surgery

Recovery

• Post-Procedure Care: Pain management, wound care instructions, stool softeners
• Recovery Time: Generally 2-6 weeks
• Restrictions: Avoid strenuous activity; follow-up appointments are necessary for monitoring healing.

Alternatives

• Non-Surgical Options: Antibiotics, seton placement (thread left in the fistula to help it drain)
• Pros and Cons: Non-surgical methods might be less invasive but often less effective in permanent resolution compared to surgical options.

Patient Experience

• During Procedure: Anesthesia will prevent pain; patient will be asleep or sedated.
• After Procedure: Postoperative pain and some discomfort are common; pain medications will be provided to manage it. Regular follow-up is advised to ensure proper healing.

By thoroughly understanding each aspect of the surgical treatment for an anal fistula, patients can be better prepared and more comfortable with the process.