Fistulotomy

Effective treatment of an anorectal fistula (an abnormal tunnel between the lining of the anus and the outside skin) requires a delicate balancing act between achieving a cure and preserving enough anal sphincter muscle to maintain continence. Fistulotomy, or “laying open”, is the preferred treatment for a simple superficial fistula located in the lower part of the anal canal, where there is little sphincter muscle to be cut through.

A fistulotomy is done as a day-stay procedure under general anaesthesia, so you will be asleep and not feel any pain. You will need to fast from midnight on the night before if your surgery is scheduled for the morning, or from 7 am if it scheduled for the afternoon.

Performed as an openprocedure, a special surgical probe is guided through the fistula tract and an assessment is made about the amount of muscle that may need to be divided. If it is minimal, the roof of the tract is cut open using diathermy (electrically induced heat). The fistula can then drain and heal from the inside out. If the amount of skin or tissue cut is significant, the edges of the cut skin may be stitched flat so that they cannot join together again and recreate the fistula. Medicated gauze is then used to dress the wound. The whole procedure takes about 30–60 minutes.

No special bowel preparation is necessary before a fistulotomy, unless you are also having a colonoscopy in the same sitting to rule out other colonic pathology that may be associated with the fistula. You will receive an enema one hour or so before your surgery.

You will be given an injection of local anaesthetic before you leave the operating theatre to help keep you pain-free in the 6 hours following your surgery. After the operation you will be transferred to the recovery area and then to the ward. You should be able to go home the same day, but sometimes patients may need to stay longer. You should not drive after your surgery, so a friend or relative will need to take you home.

Pain is common after fistulotomy when your local anaesthetic wears off. The discomfort will get better, but may take up to 6 weeks to resolve completely. It is important to keep your bowel movements soft and regular during this time. To prevent constipation, eat foods high in fibre and drink plenty of water (6–8 glasses a day). The gauze used to dress the wound during your surgery will either dissolve or fall out when you have your first bowel movement.

Analgesia and laxatives will be given to you to take home. It is best to keep up with these until your bowels are moving and any discomfort is manageable. Laxatives may need to be continued for up to one month after surgery.

You can expect minor bleeding and discharge after your surgery. A sanitary towel changed twice daily will help to prevent staining of underwear. It is normal to notice bleeding after you have opened your bowels, but if the amount of blood is more than a couple of teaspoons a day, please let my office know.

A community nurse will do the initial dressings at home or you can have these done at your local GP practice. The wound may take 4–6 weeks to fully heal over, but a nurse will not be needed for this whole period. Avoid use of soaps and chemicals on the wound area. Generally, use water to wash the wound twice a day and after every bowel movement.

Exactly when patients can resume driving after this type of surgery is determined on a case-by-case basis. This is normally 1–2 weeks, but this will be discussed with you after your surgery. Please let your insurance company know when you have been given the all-clear to resume driving.

Patients are usually able all normal activities 1–2 weeks after a fistulotomy including going back to work, within 2-4 weeks. Some people do take longer to recover.

You will have the opportunity to discuss fully all the risks and benefits of this operation with me before signing your consent form.

A follow-up appointment in the clinic will be arranged in 1–2 weeks after your surgery to check your wound and discuss any further management if required.