Home | Procedures | Fistulectomy
By Dr Bala Murali Krishna Mudiyam
Consultant in General Surgeon
Published on 21 July 2022

Article Context

  1. Overview
  2. What are the different types of anal fistulas?
  3. Procedure
  4. Care at Medicover
  5. Frequently Asked Questions

Overview

A fistulectomy is a surgical procedure performed to treat a fistula, an abnormal connection between two hollow or tubular organs, such as the blood vessels and intestine. Although fistulas can form in any part of the body, anal fistulas, which form between the skin around the anus and the end of the intestine, are the most common reason for fistulectomy. A fistulectomy is different from a fistulotomy.

The latter simply involves opening the fistulous tract to facilitate healing, while the former involves cutting it out completely. Between the two procedures of fistula surgeries, fistulectomy is considered more effective, but fistulotomy carries a lower risk of complications and faster recovery.

What Is An Anal Fistula?

The anal canal is the final part of the intestinal tract. It includes the rectum and the anus. Sometimes an abnormal passageway forms from the anal canal to the skin near the anus. This is called an anal fistula. Anal fistulas can also form the protrusion of the anal canal into other organs, such as the vagina or urinary tract.

What are the different types of anal fistulas?

Anal fistulas are classified based on their location, the various types include:

  • Intersphincteric fistula: The tract starts in the space between the internal and external sphincter muscles and ends near the anal opening.
  • Transsphincteric fistula: The tract starts in the space between the internal and external sphincter muscles or behind the anus. It then passes through the external sphincter and opens a few inches outside the anal opening. These can form a U shape around the body, with external openings on both sides of the anus.
  • Suprasphincteric fistula: The tract starts in the space between the internal and external sphincter muscles, ascends to the puborectal muscle, crosses it, then descends between the puborectal and levator ani muscles and opens an inch outside the anus.
  • Extrasphincteric fistula: The tract begins at the rectum or sigmoid colon and extends downward, passing through the levator ani muscle and opening around the anus. These fistulas are usually caused by an appendiceal abscess, a diverticular abscess, or Crohn's disease.
  • Symptoms

    Here are the symptoms of anal fistula.

  • Skin irritation and redness around the anus.
  • Growing pains around the anal region, made worse by sitting, walking, or coughing.
  • Fever associated with chills.
  • Painful bowel movement and rectal bleeding
  • Bad odour from the anus.
  • Fatigue
  • Anal abscesses
  • Swelling around the anus
  • Diagnosis

  • The doctor will carefully evaluate the medical history and anorectal symptoms and perform a rectal examination.
  • It can be done under anaesthesia or just a physical examination. Any drainage of pus (or blood or stool) and accumulated tissue seen at the external opening is related to the anal fistula.
  • When the fistula is not visible on the surface of the skin, the doctor may order an endoscopic ultrasound or an MRI scan to define the course of the fistula.
  • Internal fistulas can be evaluated by barium contrast x-ray, MRI, or CT scan. If the anal fistula is suspected to be due to digestive diseases such as Crohn's disease, the patient may need to undergo certain blood tests, X-rays, and a colonoscopic examination.
  • Other methods may also be used to help with the diagnosis. These include:

    Fistula Tube:

    A long, thin tube is guided through the outer opening of the fistula. A special dye may be injected to find out where the fistula opens.

    Anoscope:

    This is a special endoscope used to look inside your anal canal.

    Procedure

  • Fisulectomy is considered the ideal option for the treatment of anal fistulas in which a considerable amount of the sphincter muscle is affected.
  • A fistulectomy is performed in a hospital, either under general or spinal anaesthesia. It is an outpatient procedure, which means that unless complications occur during or after the procedure, the patient is discharged once the effects of the anaesthetics have worn off.
  • Depending on the severity of the condition, the surgeon may choose to inject contrast dye into the external opening of the fistula and an imaging tool, such as an X-ray or MRI, to make all parts of the fistula visible.
  • The surgeon then proceeds to remove all of the fistula while making sure that the sphincter muscle remains intact as much as possible.
  • The entire procedure takes only 45 minutes to an hour, while patients typically take 4 to 6 weeks to fully heal.
  • After the surgery

  • You are placed on regular diets, bulk agents and analgesics.
  • You are instructed to take frequent sitz baths to ensure perianal hygiene. A sitz bath is a therapy done by sitting in warm and shallow water. When you're finished, pat the anal region dry.
  • When you need to pass the bowel, place a small stool beneath your feet. This will reduce the strain on your pelvic muscles.
  • Wear a pad over your anal area until healing is complete.
  • Visit the doctor after 2 weeks.
  • Possible Risks And Complications

    A fistulectomy is an invasive procedure that involves medium to large incisions in the anal region. Therefore, it comes with a number of risks and possible complications, the main ones being postoperative pain and infection.

    Other potential risks include:

  • Severe scarring
  • Distortion
  • Reappearance
  • Incontinence
  • To help minimise or to prevent risks and complications, patients are prescribed antibiotics and given strict post-surgical care instructions after the procedure. The surgeon also schedules a series of postoperative checkups to monitor the patient's recovery.

    Comparison between fistulectomy and fistulotomy

    FistulectomyFistulotomy
    Fistulectomy is a surgical procedure in which all fistula tracts are completely excised.A fistulotomy involves cutting the fistulous tract open to allow for healing.
    It is considered as most effective as all of the fistula tract is removed completely.Fistulotomy has a shorter recovery period and a lower risk of complications.
    It may result in faecal incontinence after surgery due to possible sphincter muscle injuries.This procedure opens up the fistula tract using surgical knife or electrocautery in a way that allows anal fistula to heal from the inside out. After wound dressing and keeping the wound unsealed, the wound healing process takes approximately 4-6 weeks. The procedure may be considered for the patient with superficial anal fistula.
    Excision of the fistula or fistulectomy produces larger wounds with prolonged healing time , greater separation of muscle ends, greater risk of injuring underlying muscle and subsequent greater risk of incontinence.Fistulotomy has highest success rates but leaves a wound that heals by secondary intention.

    Care at Medicover

    At Medicover, Our general surgeons are equipped with knowledge of advanced healthcare technologies and have vast experience to perform fistulectomy with a mission to bring international standards in the field of comprehensive anorectal services. Our patient friendly hospital environment that prioritises patient’s safety and comfort have made us the best anorectal care hospital.

    Frequently Asked Questions:

    One can return to the normal routine in 1 to 2 weeks after the surgery. But it can take several weeks to several months for the fistula to fully heal.

    The fistula tract should be treated because it will not heal by itself. There is a risk of developing cancer along the path of the fistula if left untreated for a long period of time.

    A fistulectomy may take between 30 minutes and one hour, depending on the size and location of the fistula.

    If the anal fistula is not treated properly, recurrent perianal abscesses and a complex network of fistulas can develop that can cause pain, bleeding, fecal incontinence, skin infections (cellulitis), and sepsis.

    Anal fistulas are caused by an infection that starts in an anal gland. This infection results in an abscess that drains spontaneously or is surgically drained through the skin near the anus.

    Fistulectomy cost varies between INR 35,000 to INR 1,55,000 depending on the city we chose.

    References