Name of the Procedure:

Surgical treatment of anal fistula (fistulectomy/fistulotomy); second stage

Summary

The surgical treatment of anal fistula involves the removal or opening of an abnormal connection between the anal canal and the skin. The second stage of the procedure is typically performed to ensure complete healing and closure of the fistula tract.

Purpose

Medical Condition:

• Chronic anal fistula ##### Goals:
• Eliminate infection and drainage
• Promote full healing of the fistula tract
• Restore normal anal function

Indications

• Persistent drainage from an anal fistula
• Recurrence of symptoms after initial treatment
• Chronic pain or discomfort in the anal area
• Incomplete healing after the first surgical stage

Preparation

• Fasting for at least 6-8 hours before the procedure
• Stopping certain medications as advised by the doctor
• Preoperative bowel preparation may be required
• Blood tests and imaging studies (e.g., MRI, ultrasound) to assess the fistula

Procedure Description

• The patient is placed under regional or general anesthesia.
• The surgeon identifies the fistula tract using a probe.
• Depending on the complexity, the procedure might involve:
  • Fistulectomy: Complete removal of the fistula tract.
  • Fistulotomy: Opening the fistula tract to allow it to heal from the inside out.
• Any associated abscess is drained.
• The wound is left open or partially closed, allowing for optimal healing.
• Sutures or dressing may be applied as necessary.

Duration

• Typically lasts 1 to 2 hours.

Setting

• Performed in a hospital or outpatient surgical center.

Personnel

• A colorectal surgeon or general surgeon
• Anesthesiologist for sedation or anesthesia
• Surgical nurses and assistants

Risks and Complications

• Common risks: Bleeding, infection, pain at the surgical site
• Rare risks: Incontinence, recurrence of the fistula, failure to heal
• Management: Antibiotics for infection, pain medications, possible additional surgery for complications

Benefits

• Resolution of symptoms
• Prevention of complications such as recurrent infections
• Improvement in quality of life

Recovery

• Pain management with prescribed medications
• Keeping the surgical area clean and dry
• Instructions for wound care, including sitz baths
• Avoiding strenuous activities for a few weeks
• Follow-up appointments to monitor healing
• Full recovery typically within 4 to 6 weeks

Alternatives

• Seton placement: Involves placing a thread to help drain the fistula
• Fibrin glue or plug: Minimally invasive options, though success rates may vary
• Pros and Cons: Alternatives may be less invasive but could have lower success rates and may require additional interventions

Patient Experience

• During: The patient will be under anesthesia and should not feel any pain during the procedure.
• After: Postoperative pain can be managed with medications. Some discomfort and drainage may occur, but this will decrease as healing progresses. Prompt communication with the healthcare team is important to address any concerns.