Anal fistula surgery is a surgical treatment used for managing anal fistulas, primarily targeting infected fistulous tracts between the anus and surrounding tissues. The main goal is to thoroughly remove infected tissue, sever the fistula tract, and promote healthy tissue regeneration to prevent recurrent inflammation or chronic ulcers. The procedure is typically suitable for patients unresponsive to medication or with fibrotic fistula structures, effectively reducing complications and improving quality of life.
The surgical approach must be tailored based on the fistula’s course and the patient’s anal anatomy. Common types include open fistulotomy, fistula filling, and others. Postoperative care involves cleaning and regular follow-up to ensure complete healing of the fistula.
Anal fistula surgery is mainly divided into three categories: 1) Fistulotomy: directly opening the fistula and removing infected tissue to allow the wound to heal by secondary intention; 2) Fistula Filling: using biological materials or autologous tissue to fill the fistula, promoting granulation tissue growth; 3) Sphincter-sparing Surgery: designed for high fistulas to avoid damaging the anal sphincter and maintain continence.
The mechanism involves destroying the source of infection and establishing a healthy healing environment. For example, fistulotomy involves opening the fistula to expose tissues to air, accelerating drying and healing; filling techniques use biological scaffolds to guide new tissue growth. Modern technologies incorporate image guidance or laser therapy to improve fistula localization accuracy.
This treatment is indicated for conditions such as:
Contraindications include severe coagulation disorders, uncontrolled diabetes, or immunodeficiency. Patients should be evaluated by a physician for overall health status before surgery.
The procedure is usually performed under general or spinal anesthesia. Preoperative imaging such as anoscopy or MRI is used to locate the fistula path. The operation lasts approximately 1-3 hours depending on complexity. Patients typically stay hospitalized for 1-3 days, with daily wound cleaning and administration of analgesics and antibiotics.
There is no fixed "dosage," but the surgeon adjusts the surgical extent based on fistula length and location. Complex fistulas may require staged procedures or combined tissue transplantation techniques.
Main benefits include:
Modern techniques emphasize sphincter preservation, such as the LIFT procedure (Ligation of Intersphincteric Fistula Tract), which reduces the risk of incontinence. For patients suffering long-term from fistulas, surgery offers a definitive solution, preventing chronic inflammation and potential malignant transformation into anal fistula cancer.
Potential risks include:
Serious complications such as anal stricture or deep tissue injury occur in less than 5% of cases. Patients should closely monitor healing progress and seek immediate medical attention if persistent bleeding or high fever occurs.
Preoperative preparation includes blood sugar control and bowel cleansing. Diabetic patients should keep blood glucose within normal ranges. Within 2-4 weeks post-surgery, patients should avoid heavy lifting or prolonged sitting, and perform daily sitz baths with potassium permanganate solution to clean the wound.
Contraindications include:
Antibiotic therapy is recommended before and after surgery, but long-term use of broad-spectrum antibiotics should be avoided to reduce resistance. Patients on anticoagulants should discontinue or adjust medication 7 days prior to surgery.
There is no direct interaction with radiotherapy, but if anal cancer is suspected, tissue biopsy should be performed first to exclude malignancy.
According to a 2020 study in the British Journal of Surgery, open fistulotomy has an 89% healing rate at 5 years, while biological scaffold filling improves healing rates for complex fistulas to 93%. Clinical follow-up shows that sphincter-preserving procedures reduce incontinence risk to below 2%. Long-term studies confirm that postoperative anal function impairment is lower than with traditional excisional surgery, indicating significant improvements in patients’ quality of life with modern techniques.
Non-surgical options include:
However, these methods only temporarily control inflammation and cannot eliminate the fistula structure. Pharmacological treatments are less effective for patients with severe fibrosis, making surgery the standard approach.
Patients should undergo detailed anal examinations and imaging (such as MRI or ultrasound) to assess the fistula’s course and its relationship with the anal sphincter. Discontinue anticoagulants one week before surgery and follow medical advice for bowel cleansing to reduce infection risk. Fasting is required on the day of surgery, and patients should bring ID and signed consent forms.
What methods are used for pain management after surgery?Postoperative pain is managed with analgesics such as NSAIDs or opioids. Doctors may recommend sitz baths with potassium permanganate to promote healing and advise avoiding prolonged sitting or heavy lifting. Sudden worsening of pain or fever warrants immediate medical attention.
When can normal diet and bowel movements resume after surgery?Liquid diet can be resumed within 24 hours, gradually transitioning to high-fiber foods to prevent constipation. Bowel movements should be relaxed, avoiding straining. Normal diet typically resumes within 2-4 weeks, but depends on individual healing, following doctor’s instructions.
Will scars affect anal function after surgery?Modern minimally invasive techniques (such as LIFT or biological glue filling) aim to preserve the anal sphincter, reducing the risk of stricture or incontinence. Severe cases may require partial muscle removal, with risks explained beforehand. Postoperative follow-up and physical therapy can help improve function if needed.
Is recurrence common after surgery?Traditional fistulotomy has a recurrence rate of about 10-20%, while biological glue or fistula reconstruction techniques can reduce recurrence to below 5%. Risks depend on the underlying cause (e.g., Crohn’s disease) or poor healing. Maintaining bowel regularity, avoiding inflammation, and regular follow-up are essential for prevention.
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