Table of ContentsView AllTable of ContentsWhat It IsPurposeHow to PrepareWhat to ExpectRecovery
Table of ContentsView All
View All
Table of Contents
What It Is
Purpose
How to Prepare
What to Expect
Recovery
A fistulotomy is a surgical procedure used to treat afistula. A fistula occurs when two organs or tracts form an abnormal connection. Fistulotomy is most commonly used to treat uncomplicated perianal fistulas (those occurring in and around the anus).
These typically occur when anabscessdevelops in perianal tissues and breaks through the walls of adjacent structures as it grows. Fistulotomy can help open and drain the pocket so that the tissues can heal and close the abnormal passage.
This article will explore why surgery is needed, how to prepare, and what to expect from surgery and recovery.
What Is Fistulotomy?
Fistulas can develop in different parts of the body due to an infection, injury, surgery, or severeinflammation. Fistulotomy is one of several techniques that can be used to treat them, but it is typically reserved for cases involving the anus or rectum.
More specifically, fistulotomy is primarily used to treat simple fistulas—that is, those that are situated low (near the anal sphincters) that have a single opening between the adjacent structures.
Fistulotomy can be performed in a healthcare provider’s office, particularly when fistulas are small and shallow. Larger fistulas may need to be treated in a hospital operating room undergeneral anesthesia. Depending on the size and location of the repair needed, it can be a major surgery or a minor procedure.
What’s the Difference Between a Fistulotomy and a Fistulectomy?
Fistulotomy should not be confused with a fistulectomy. Both fistulotomy and fistulectomy are procedures to correct an anal fistula. Fistulectomy removes the entire fistula, including some tissue surrounding it. A more complex surgical procedure is needed in more severe cases or when the fistula is likely to recur.Your provider will discuss which approach is needed in your case.
Anal Sphincter Function, Anatomy, and Complications
Contraindications
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 localradiation therapyorinflammatory bowel disease (IBD).Forward-lying (anterior) fistulas in women, typically involving vaginal tissues, are also considered complex.
Because vulnerable tissues are involved with these types of fistulas, there is a significant risk of recurrence andfecal 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.
The recurrence rate of a fistula following surgery is anywhere from 5% to 50%, while the risk of fecal incontinence (ranging from mild to severe) is as high as 40%.
What Is a Rectovaginal Fistula?
Potential Risks
As with all surgical procedures, fistulotomy poses a risk of injury and complications. Some 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:
What Is the Purpose of a Fistulotomy?
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 goal of the surgery is to minimize injury to (or the cutting of) the anal sphincter to preserve sphincter function.
Fistulotomy can be used in more than 50% of fistula cases.When used appropriately, the surgery can offer a cure rate close to 100%, whether in the initial surgery or after an additional procedure if the fistula recurs.
Decision to Treat
A fistulotomy is generally the first procedure considered for superficial fistulas located between the internal and external anal sphincters. These 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,sphincteroplasty, may be needed to rebuild the sphincter following the fistulotomy. It is a technically complicated surgery that many surgical centers do not offer.
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 assepsisandanal cancer.
Criteria for Selection
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 determining that a fistulotomy is appropriate, an appointment to perform the surgery would be scheduled. A gastroenterologist or ageneral internistwho has undergone additional training in the gastrointestinal tract may handle less-complicated cases.
6 Tips for When You Have No One to Help After Surgery
Location
Depending on the size and location of the fistula, a fistulotomy can be performed in a hospital, surgical center, or a gastroenterologist’s office.
What to Wear
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. 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.
Food and Drink
Thoughbowel preparationis 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.
Medications
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 before the procedure, while others may need to be temporarily stopped during recovery.
The drugs of concern typically include:
What to Bring
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 yourcopay 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.
What to Expect on the Day of Surgery
Before the Surgery
Once you are checked in and have signed the necessary consent forms, you will be escorted to the back to change into a hospital gown. Aftervital signsare checked, an intravenous (IV) line will be inserted into a vein in your arm to deliver medications and fluids.
The anesthesiologist will also meet with you to discuss anydrug allergiesyou have and whether you have had adverse reactions to anesthesia in the past. The anesthesiologist should also advise you about which type of anesthesia is being used and why.
The Side Effects and Complications of General Anesthesia
During the Surgery
Once you have been prepped for surgery, you will likely be given either ageneral anestheticto put you completely to sleep or a form of sedation calledmonitored anesthesia care (MAC)that induces “twilight sleep.” This will be pushed through your IV.
Pre-operativeantibioticswill be delivered through the IV line to aid with healing and help prevent infection.
Depending on the location and position of the fistula, you may be placed in one of three positions:
During the fistulotomy, the healthcare provider will make an incision to open the abnormal opening between the two structures. An anal retractor gently opens the anus while the fistula itself is cut with a scalpel. Every effort will be made to avoid or limit damage to the anal sphincters.
Once open, the base of the wound iscuretted(scraped). The wound is then left open to heal on its own. If needed,marsupialization(in which the cut edges of the wound are stitched) may be used to promote drainage, reduce bleeding, and provide better pain control.
Finally, the wound is either packed or covered with gauze and bandaged to help keep it clean.
A fistulotomy can take anywhere from 30 minutes to an hour to perform, depending on the size and location of the fistula.
After the Surgery
After surgery, you are taken to a recovery room and monitored until fully awake. Food and drink may be given, as well asanti-nausea medicationif you feel nauseous. It is not uncommon to experience rectal pain and discomfort immediately after a fistulotomy, even if a local anesthetic was used.
Once you are stable enough to walk and change into your clothes, the nurse will send you home with pain medications, antibiotics, sanitary pads or diapers, and wound care instructions. A friend or family member will need to drive you home and ideally stay with you overnight to monitor for complications.
Verywell / Brianna Gilmartin
Once you return home, regardless of the type of anesthesia used, you should relax for the rest of the day.Do not bathe or shower for the first day. To reduce discomfort, lie on your side when relaxing or sleeping, wear loose-fitting clothes and underwear, and limit the amount of walking you do.
After that, expect to spend a week or two recovering, which involves wound management, pain control, changes in diet, and restricting physical activity.
With proper care, most people can return to work and regular activity within one to two weeks of a fistulotomy.
Healing
Your healthcare provider will provide you with instructions as to how often you need to change the dressing on your wound. In the early days, you may need to do so up to four times a day, packing the wound gently with sterile gauze to absorb any fluids or blood. After that, the dressing can usually be changed daily.
You may be provided atopical antibioticto use during the initial stages of healing as well as oral antibiotics that you should take as directed and to completion.
During recovery, it is important to avoid strenuous physical activity, heavy lifting, or positions like deep squatting that can open a wound. It also helps to sit on soft pillows or a donut-shaped pillow (available online or in many drugstores) to reduce pressure on the wound.
It is important to note that, even with proper care, complications of fistula surgery can sometimes occur. The length of time it takes to heal after fistulotomy depends on a variety of factors, including the severity of the fistula and whether you encounter any complications.
When to Call a Healthcare ProviderCall your surgeon immediately if you experience any of the following after undergoing a fistulotomy:Heavy, uncontrollable bleedingIncreasing pain, redness, swelling or discharge at the surgical siteA high temperature (over 100.5 F) with chillsDifficulty or inability to urinateConstipation for more than three daysNausea and vomiting
When to Call a Healthcare Provider
Call your surgeon immediately if you experience any of the following after undergoing a fistulotomy:Heavy, uncontrollable bleedingIncreasing pain, redness, swelling or discharge at the surgical siteA high temperature (over 100.5 F) with chillsDifficulty or inability to urinateConstipation for more than three daysNausea and vomiting
Call your surgeon immediately if you experience any of the following after undergoing a fistulotomy:
People often worry about bowel movements during recovery from fistula surgery, which may not only be painful but difficult to clean. To help ease pain during bowel movements, eat afiber-rich dietand use alaxative or stool softeneryour surgeon prescribes.
Avoid using terrycloth towels or sponges to clean the wound. After washing, pat rather than rub the skin dry. Alternately, you can use a hairdryer set to the lowest settings (both temperature and strength) to dry the skin gently.
How to Use a Sitz Bath
Pain Control
Pain can usually be controlled with an over-the-counter pain reliever likeTylenol (acetaminophen)and/or a topical anesthetic like lidocaine. Fifteen-minute sitz baths can also help.
If the pain is especially severe, your healthcare provider may prescribe an opioid painkiller like Vicodin (hydrocodone), but usually for only a few days to avoidopioid dependence.
How to Deal With Post-Surgical Pain
Long-Term Care
Fistulotomy is highly effective in resolving simple perianal fistulas. If the fistula heals without complications, it usually won’t return or require ongoing medical care.
Summary
Possible Causes of Bloody Stools
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Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
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