Fistula surgery how long does it takes

Fistulotomy is contraindicated for the treatment of complex fistulas. These include those that lie above the anal sphincter where there is more muscle , have multiple openings, or are the result of local radiation therapy or inflammatory bowel disease IBD.

Because vulnerable tissues are involved with these types of fistulas, there is a significant risk of recurrence and fecal incontinence the inability to control bowel movements. For these same reasons, fistulotomy is avoided in people with recurrent fistulas or those with pre-existing fecal incontinence.

As with all surgical procedures, fistulotomy poses a risk of injury and complications. Some of these can occur immediately after the procedure, while others may develop within weeks or months. Early complications of fistulotomy include:. Delayed complications occur less commonly but can include:. The goal of a fistulotomy is to drain pus and fluids from fistulated tissues, allowing them to heal while closing the abnormal opening between the tracts.

The intent of the surgery is to minimize injury to or the cutting of the anal sphincter in order to preserve sphincter function. Fistulotomy is generally the first procedure considered for superficial fistulas located between the internal and external anal sphincters. These types of fistulas can usually be treated quickly and effectively in an in-office procedure. Large fistulas that have grown into deeper tissues can be treated in an operating room, but other options may be considered.

This is because an additional procedure, called sphincteroplasty, may be needed to rebuild the sphincter following the fistulotomy. It is a technically complicated surgery that many surgical centers do not offer.

In its place, other staged procedures, such as a seton a technique used to create a temporary drainage canal followed by surgery to close the opening with electrocautery, laser surgery, or biologic glues may be preferred. Fistulas should never be left untreated as they will not heal on their own.

Untreated fistulas can lead to long-term or potentially life-threatening complications, such as sepsis and anal cancer. In order to determine if fistulotomy is appropriate, the healthcare provider will perform a digital rectal exam using a gloved finger to estimate the size and location of the fistula.

If performed by a gastroenterologist , the digital exam may be all that is needed to make the initial diagnosis. Other tests would then be ordered to pinpoint the exact position and pathway of the fistula, including:. These tests can help direct how a fistulotomy is approached and determine if other surgical procedures should be considered instead.

Upon determination that a fistulotomy is appropriate, an appointment would be scheduled to perform the surgery. Less-complicated cases may be handled by a gastroenterologist, a general internist who has undergone additional training in the gastrointestinal tract. If you are referred to a surgeon for the procedure, a separate appointment would be scheduled to review the findings and discuss the surgery from preparation to recovery.

A fistulotomy can be performed by a colorectal surgeon , also known as a proctologist, who is board-certified in general surgery and has undergone additional training in colon and rectal surgery. Depending on the size and location of the fistula, a fistulotomy can be performed in a hospital, surgical center, or a gastroenterologist's office.

As you will need to change into a hospital gown, wear something loose-fitting and comfortable that you can easily remove and put back on.

Leave any valuables at home, including watches and jewelry. Note that you will be asked to remove contact lenses, dentures, hearing aids, and piercings before the surgery. After the procedure is performed, the nurse will provide sanitary pads to place in your underwear if there is any bleeding.

You should stop eating at midnight on the night before the surgery. Up to four hours before the procedure, you can drink a small amount of water to take any morning pills if approved by your surgeon. Within four hours, you cannot drink or eat anything, including gum or ice chips. Though bowel preparation is not required for fistulotomy, some healthcare providers recommend using a single enema the morning of the procedure to help clear the bowel of any fecal residue.

Your healthcare provider will advise you to stop taking certain medications that can promote bleeding and slow wound healing. Some may need to be stopped one or several days in advance of the procedure, while others may need to be temporarily stopped during recovery.

The drugs of concern typically include:. Your healthcare provider may also recommend that you stop smoking for a week or two following surgery. Smoking causes the narrowing of blood vessels and can slow healing by reducing the amount of oxygen that reaches the wound. Be sure to bring your driver's license or other form of government ID , insurance card, and an approved form of payment if the facility requires upfront payment of your copay or coinsurance.

You will also need to bring someone with you to drive you home. Even if general anesthesia is not used, you will almost invariably be too groggy and uncomfortable to drive yourself safely.

Fistulas are usually the result of infection or inflammation due to injury or surgery. They can occur in many parts of the body, but the most common types of fistula are:. Anal or perianal fistulas , which form between:. Urinary tract fistulas, which form between:.

Gastrointestinal fistulas , which form between:. Aortoenteric fistulas can form between the native aorta and the duodenum or jejunum or between a prosthetic aortic graft and any portion of the gastrointestinal tract.

Although people can usually manage the other types of fistula listed above as an outpatient on an elective basis, aortoenteric fistulas are surgical emergencies.

People will experience different symptoms depending on where in the body their fistula is located. Symptoms of aortoenteric fistulas include bloody diarrhea or vomit and sudden-onset low blood pressure. Inflammation causes ulcers to form that can expand to reach another surface inside the body. This creates a channel that helps drain pus from an infected area.

Some fistulas may heal with the help of antibiotics and other medications, but most require surgery. The main options for surgical treatment of an anal fistula are fistulotomy and seton surgery.

Fistulotomy refers to when a surgeon cuts a fistula along its whole length so that it heals into a flat scar. During seton surgery, a surgeon will place a piece of thin surgical thread inside the fistula to help drain any infection and allow it to heal.

Other treatment options include:. All procedures for treating fistulas have different benefits and risks. Seton techniques If your fistula passes through a significant portion of anal sphincter muscle, the surgeon may initially recommend inserting a seton.

This allows it to drain and helps it heal, while avoiding the need to cut the sphincter muscles. This may require several procedures that the surgeon can discuss with you. Advancement flap procedure An advancement flap procedure may be considered if your fistula passes through the anal sphincter muscles and having a fistulotomy carries a high risk of causing incontinence.

LIFT procedure The ligation of the intersphincteric fistula tract LIFT procedure is a treatment for fistulas that pass through the anal sphincter muscles, where a fistulotomy would be too risky. Endoscopic ablation In this procedure, an endoscope a tube with a camera on the end is put in the fistula. An electrode is then passed through the endoscope and used to seal the fistula.

Endoscopic ablation works well and there are no serious concerns about its safety. Laser surgery Radially emitting laser fibre treatment involves using a small laser beam to seal the fistula.

There are uncertainties around how well it works, but there are no major safety concerns. Fibrin glue Treatment with fibrin glue is currently the only non-surgical option for anal fistulas. Bioprosthetic plug Another option is the insertion of a bioprosthetic plug.

The types of fistula surgery include:. The recovery time for fistula surgery depends on the type of surgery a person has, their overall health, whether they have an infection, and the skill of the surgeon.

Success rates also vary and can affect how soon a person feels better. Delayed referral for surgery increased the risk of incontinence, while secondary growths on the fistula increased the risk of surgery failure.

With a fistulotomy, a person will usually go home the same day. They may have some pain and drainage from the wound but should be able to return to work within a day or two.

A doctor will usually recommend against heavy lifting and sexual activity for a few weeks. A fistulectomy has a longer recovery time because a person needs general anesthesia. This means they will need to have the procedure in the hospital and may need to stay overnight for monitoring.

There is a higher risk of infection and incontinence with this type of surgery. A person may need several weeks to feel better and may need to stay home from work for a few days. After a person fully recovers, in most cases, the fistula heals, and a person will not have lingering issues such as incontinence. But if there are surgical complications, a person may need additional treatment or more surgery.

A seton drain is a drain that can help heal anal fistulas. Some fistula surgeries involve placing such a drain to help remove pus and other fluids from infection and heal the fistula. A person may have spotting or bleeding for 1—2 days after the procedure, and pain for 1—2 weeks. In most cases, a person can return to work the day following the procedure if they feel well. There is a small risk of incontinence , infection, and other complications. People who notice pain, bleeding, or a bad smell should see a doctor right away.