Fistula Surgery : Purpose, Procedure, Benefits and Side Effects

Fistulotomy or fistula surgery is done to completely remove a fistula so that it can heal into a flat scar. Surgery is necessary for the complete eradication of the fistula. Depending on where the fistula is and how severe the symptoms are, different surgical procedures are used. Pre-surgical processes are followed to determine the right type of surgery required by specific patients.

Anal fistulas typically do not heal on their own, hence surgery is required to treat them. The type of surgery depends on various factors such as the position of the fistula and whether it is a single channel or branches out in several directions. There are numerous distinct processes to surgically treat anal fistula, some of which are;

Surgery is the only effective treatment for a persistent anal fistula. Very few anal fistulas heal on their own. The quality of a person's life can be substantially impacted by a fistula. Fistula surgery is successful for the majority of patients, and recurrence rates are minimal. For instance, a fistulotomy has a success rate of 92–97% over the long term.

Here are some of the many benefits of fistula surgery;

• No anal abscesses post surgery
• Pain and swelling around the anus also cured
• Bloody or foul-smelling drainage (pus) and the pain may decrease after the fistula drains
• No more pain with bowel movements
• No more bleeding

Summary- Benefits of fistula surgery include- treatment of pain and swelling, painless bowel movements, reduction of anal abscesses, etc.

Fistulas can develop as a result of surgery, bodily injury, or severe inflammation brought on by an infection or inflammatory bowel diseases like Crohn's disease and ulcerative colitis. A fistula surgery is needed to cure the infection and drain the abscess that resulted from these conditions. The aim of surgery is to seal the fistula while avoiding damage to the sphincter muscles, a ring of muscles that open and close the anus and is responsible for bowel control.

Fistulas must be treated since they won't heal on their own; and when they really don’t, there is a possibility that cancer will spread to the fistula tract. The majority of fistulas require surgical intervention.

Summary- Fistula surgery is done to relieve the fistula symptoms and their adverse effects.

Just like any other form of surgery, Fistula Surgery entails some risks. The primary risks are:

• Infection: If severe, this may need to be treated in a hospital with a course of antibiotics.
• Recurrence of the fistula: Despite surgery, the fistula might occasionally come back.
• Bowel incontinence: It is a potential complication associated with the majority of anal fistula treatments, while severe incontinence is uncommon and will be avoided at all costs.

The location of your fistula and the particular procedure you have will affect the level of risk. Ask your surgeon about any possible dangers associated with the recommended operation procedure.

Summary- Some risk factors often associated with fistula surgery are- bowel incontinence, recurrence of the fistula, and certain infections.

As general anesthesia is used during anal fistula surgery, you will be sleeping throughout the operation. Hence, there are some preparations like refraining from eating and drinking hours before going to the operation theater. Some of the preparations for anal fistula surgery are;

• Need to fast for six hours. However, up until two hours before the procedure, some anesthesiologists permit brief sips of water
• Nurses may take your heart rate, blood pressure, and urine samples while you're in the hospital
• Nurse may prepare you with a bowel washout (an enema)
• In order to prevent blood clots from forming in the veins in your legs, you could also be required to wear compression stockings or an anti-clotting medication, which may be administered intravenously in place of stockings
• A consent document will be provided to you by your surgeon. This attests to the fact that you are aware of the procedure's risks, advantages, and potential substitutes and have given your consent for it to proceed.

Summary- Before undergoing fistula surgery, we need to follow some rules to be prepared for the surgery.

Typically, the procedure lasts 30 minutes. Depending on the type of fistula you have, a specific operation will be required. Your surgeon will evaluate the fistula and choose the most effective course of action. Your healthcare professional will do a digital rectal exam using a gloved finger to estimate the size and location of the fistula in order to decide whether fistulotomy is necessary. The digital exam, if carried out by a gastroenterologist, can be sufficient to determine the initial diagnosis.

Surgeons often let fistula 'lay open' if it is only superficial so that it can begin to mend inside. At times, it's important to leave a thread of material, such as suture material, in the fistula tract. It might be necessary to leave a seton in place for a while. The fistula is often covered with a bandage until it has entirely healed. To close the fistula, a unique protein-based glue or plug may occasionally be employed.

Summary- Fistula surgery is carried on by following some distinct procedures as stated above.

In India, the cost of a fistula surgery can range from Rs. 45,000 to Rs. 60,000. Here is an estimated cost of anal fistula surgery across various cities in India;

The type of hospital and other varied elements could also influence this pricing variance. The price of fistula surgery depends on some of the following variables, such as;

• The kind of hospital and its location
• Consultation fee of the doctor
• Charges for transportation to and from the hospital
• The price of laboratory or diagnostic tests
• Type and grade of treated piles (grade I, grade II, grade III, grade IV)
• Technology used in surgery
• Any other pre-existing medical condition
• The kind of operation done
• Pre and post-operative appointments’ charges
• The cost of hospitalization
• Daycare charges
• Medication charges
• Insurance cover

Notably each of these factors may have an impact on the price of an Indian fistula surgery. So, consider each of these factors when estimating the cost of a fistula operation. You can also look into your insurance coverage for the costs of your fistula surgery.

Summary- Fistula treatment costs usually lie between 45,000-60,000.

Your doctor could give you a handful of instruction for fast and smooth recovery and to subside the pain and other problems that could arise post fistula surgery;

• Sitz bath, which involves bathing the affected area in warm water. In a sitz bath, you need to sit in warm salty water (8 to 10 cm) for 15 to 20 minutes per day
• Laxatives or stool softeners for a week
• Rest until the anesthetic's effects wear off in order for the abscess and fistula to heal correctly and hopefully prevent a recurrence
• Your doctor may prescribe painkillers or inject a local anesthetic to ease your discomfort after your general anesthetic wears off
• Daily dressing of the wound formed after surgery until it heals.
• A course of antibiotics. It's crucial to finish the course of antibiotics if you've been prescribed them.

Summary- We should follow some post-surgical tips to avoid complications.

You may consume your typical diet. Try bland, low-fat items such as plain rice, grilled chicken, bread, and yogurt if your stomach is disturbed. Drink a lot of water (unless your doctor tells you not to). Every day, include high-fiber items in your diet, such as fruits, vegetables, legumes, and whole grains. Here are some of the food items that you can easily consume after anal fistula surgery;

• Cereals: Brown rice, oatmeal, broken wheat, ragi, quinoa
• Pulses: Chickpeas, kidney beans, moong dal, masoor dal, soybeans
• Vegetables: All gourds-bitter gourd, snake gourd, ridge gourd, bottle gourd, ivy gourd, ladies finger, tinda, green leafy vegetables
• Fruits: Custard apple, pears, grape and watermelon, oranges and apple
• Milk and milk products: Skim milk, paneer, cottage cheese, yogurt
• Meat, Fish and Egg: Tuna, salmon, herring, mackerel.

Summary- We should incorporate nutritious foods to combat fistula.

Just like any other surgery anal fistula also has its fare share of complications. Any procedure could have unanticipated side effects from the anesthetic, excessive bleeding, or the development of a blood clot, typically in a vein in the leg (Deep Vein Thrombosis or DVT). Although they are very rare.

Here are some specific complications that can arise from anal fistula surgery:

• Infection: This may lead to an anal abscess and require further treatment
• Injury to the sphincter muscles: This can cause fecal
• incontinence and disrupt bowel control

Summary- Although, fistula surgery consists of certain complications it is considered safe.

As patients are administered general anesthetic, putting them to sleep, or regional anesthesia, which keeps the patient awake but numbs the area which is to be operated on, it is highly unlikely for them to feel any pain or discomfort during the anal fistula surgery. Although, as the anesthetic wears off, you might experience some discomfort, but your medical staff will provide you with painkillers.

Moreover, following the surgery, you probably won't feel completely comfortable for around a week and may experience some pain and bleeding from the wound. For such tough times your surgeon may prescribe you some over-the-counter painkillers like paracetamol or ibuprofen.

Summary - Fistula surgery involves the administration of anesthesia to combat pain.

It should take around six weeks for your wound to completely heal. You might need to return to the hospital every day so that they can change the dressings to help keep your wound clean and heal, depending on the extent of the wound. How long you will require dressings will also be discussed by your surgeon. You might find it helpful to wear a gauze pad in your underwear for the first week or two to protect your clothing from any wound leakage.

Summary - Usually 2 months are required for recovery from fistula surgery.

A person may have the following side effects after anal fistula treatment:

• Cramping
• Nausea
• Constipation
• Diarrhean
• Pain at the wound's location

Once the body starts to heal, these adverse effects ought to disappear after a few days.

Summary- There are some adverse effects often accompanied by fistula surgery.

Following surgery, it's crucial that patients relax for a few days. Along with some rest, your doctor may also recommend some aftercare to help ease the pain and ensure a normal recovery. Here are some aftercare tips for patients with anal fistula surgery;

• Rest until the anesthetic's side effects wear off
• Stand up and move around a little with your nurse's help when you're ready. This will lessen the likelihood of difficulties
• Take painkillers provided to you by the medical staff to soothe the pain and discomfort after your anesthesia wears off following the operation
• If a topical ointment was prescribed, apply it to the anal surface and a small amount inside the anal canal 2-3 times per day
• Don't drive, consume alcohol, use machinery, or make any significant decisions in the interim
• Follow a diet that is high in fiber, is not extremely oily or spicy, and has lots of clear fluids, for regular soft stools
• Engage in regular, gentle exercise because it will improve both your physical and emotional health
• Your healing will be assisted by consistent showering, sleeping, and relaxing

Visit clinic for follow-up care

After surgery, if you experience any urination issues, you could initially require a catheter (a tube that drains urine from your bladder).

Follow the instructions of your doctor on how to take care of your wounds, how to spot infection symptoms, and how to take pain medication after leaving the hospital

Also, schedule a follow-up appointment with your doctor as directed by your treating medical professional. The initial follow-up appointment is typically scheduled for 3 weeks after surgery, although if a seton was implanted, the doctor might want to see you sooner.

Summary- Aftercare tips are very effective in soothing the recovery phase.

Living with a fistula is rarely a lifelong condition given the variety of surgical treatments available in today's world. Fistula diagnosis, treatment, and recovery can take a long time and be frustrating. However, with so many treatment options anyone can get their fistula removed irrespective of their age and severity of the condition.

Also, diet, hygiene and exercises play a crucial role after anal fistula surgery, hence you should follow the guidance of your healthcare provider to heal your wounds soon.