Fistulotomy
What is Fistulotomy?
.
Why do you need Fistulotomy?
Anal fistulas typically develop from untreated or recurrent perianal abscesses and cause symptoms like pain, swelling, discharge, or recurrent infections. Fistulotomy is indicated for:
- Simple anal fistulas: Low-lying, superficial fistulas (e.g., intersphincteric or low transsphincteric) involving minimal sphincter muscle.
- Chronic or recurrent fistulas: Persistent fistulas after failed conservative management or drainage.
- Symptomatic fistulas: Causing pain, pus discharge, or recurrent abscesses.
- Fistulas without complex anatomy: Not associated with Crohn’s disease, high transsphincteric tracts, or multiple branches.
Why Do Costs Vary in Philippines?
.
Fistulotomy Procedure
The procedure is relatively straightforward and typically performed as a day-care or short-stay surgery:
- Before Procedure Evaluation:
- Diagnosis is confirmed via:
- Physical examination: Identifies the external opening, discharge, or abscess.
- Proctoscopy or sigmoidoscopy: Visualizes the internal opening in the anal canal.
- MRI or fistulography: Maps the fistula tract, especially for complex or recurrent cases, to assess sphincter involvement.
- Blood tests ensure surgical fitness, particularly for patients with comorbidities.
- Bowel preparation (enemas or laxatives) may be advised to reduce contamination.
- Patients are counseled on post-operative care, pain management, and potential risks (e.g., incontinence).
- Diagnosis is confirmed via:
- Surgical Technique:
- Open Fistulotomy:
- Performed under general, spinal, or local anesthesia with sedation, lasting 15–45 minutes.
- The patient is positioned in the lithotomy (legs raised) or prone position.
- The surgeon identifies the fistula tract using a probe, then cuts open the entire tract from the internal to the external opening, converting it into an open wound.
- The wound is left open to heal by secondary intention, promoting drainage and preventing recurrence.
- Surrounding scar tissue or abscess cavities are excised to ensure complete healing.
- Laser-Assisted Fistulotomy:
- A minimally invasive variant using a laser probe to ablate the fistula tract, reducing tissue trauma.
- Suitable for simple fistulas, offering less pain and faster healing but higher costs.
- Less common, available in advanced centers like Apollo or Fortis.
- Combined Procedures:
- For complex fistulas (e.g., high transsphincteric), fistulotomy may be combined with seton placement (a thread to maintain drainage) or other techniques (e.g., LIFT, advancement flap) to minimize sphincter damage.
- The procedure is typically outpatient, with same-day discharge unless complications arise.
- Open Fistulotomy:
- After Procedure:
- Patients are monitored for a few hours to ensure recovery from anesthesia and pain control.
- Pain medications (e.g., paracetamol, ibuprofen) and stool softeners (e.g., lactulose) ease bowel movements and reduce strain.
- Sitz baths (warm water soaks) 2–3 times daily promote healing and hygiene.
- Follow-up visits assess wound healing and symptom resolution.
Recovery After Fistulotomy
Recovery is relatively quick but requires diligent wound care to ensure healing:
- Hospital Stay:
- Most patients are discharged the same day (outpatient) or within 24 hours.
- Rarely, a 1–2 day stay is needed for pain management or complex cases.
- Post-Procedure Care:
- Pain is significant for the first 1–2 weeks, especially during bowel movements, managed with oral painkillers and sitz baths.
- Stool softeners and high-fiber diets prevent constipation and reduce strain.
- The anal area must be kept clean and dry to prevent infection; patients are advised to shower after bowel movements or use wet wipes.
- Topical creams (e.g., lignocaine) may be used for local pain relief.
- Activity and Diet:
- Light activities (e.g., walking) resume within 1–2 days; strenuous activities (e.g., heavy lifting, sports) are avoided for 2–4 weeks.
- A high-fiber diet (fruits, vegetables, whole grains) and 2–3 liters of water daily promote soft stools.
- Avoid spicy foods, alcohol, or caffeine, which may irritate the bowels or worsen pain.
- Follow-Up:
- Follow-up visits at 1–2 weeks and 4–6 weeks assess wound healing and symptom resolution.
- The wound typically heals within 4–8 weeks, with pain subsiding significantly by 2–3 weeks.
- Long-term follow-ups are rare unless recurrence or incontinence occurs.
Most patients resume normal activities within 1–3 weeks, with healing rates of 90–95% for simple fistulas. Recurrence is low (2–10%) with proper surgical technique and lifestyle changes.
Risks and Complications
Fistulotomy is a low-risk procedure but carries potential complications:
- Surgical Risks:
- Bleeding or infection at the surgical site, requiring antibiotics or drainage.
- Delayed wound healing, particularly in patients with poor hygiene or comorbidities (e.g., diabetes).
- Sphincter-Related Risks:
- Fecal incontinence (gas or minor leakage) in 1–10% of patients, especially if significant sphincter muscle is divided, though usually temporary.
- Anal stenosis (narrowing), requiring dilatation or further surgery.
- General Risks:
- Adverse reactions to anesthesia.
- Recurrence of fistula (2–10%), particularly if the tract is not fully opened or underlying infection persists.
- Long-Term Issues:
- Chronic pain or discomfort, rare with proper healing.
- Fistula recurrence in complex cases or Crohn’s disease patients.
Prompt reporting of symptoms like excessive bleeding, fever, or incontinence ensures timely management.
Frequently Asked Questions (FAQs)
What causes an anal fistula?
Most fistulas result from infected anal glands leading to abscesses, often triggered by trauma, constipation, or infections. Crohn’s disease or tuberculosis can also cause fistulas.
Can a fistula heal without surgery?
Rarely, small fistulas may resolve with antibiotics or drainage, but chronic or symptomatic fistulas typically require surgery like fistulotomy.
Is fistulotomy the only treatment for anal fistulas?
Simple fistulas are best treated with fistulotomy. Complex fistulas may require seton placement, LIFT, or advancement flap to minimize incontinence risk.
How soon can I resume normal activities?
Light activities resume in 1–2 days; normal routines (work, driving) resume in 1–3 weeks.
Is fistulotomy covered by insurance in India?
Most insurance plans cover fistulotomy for symptomatic or chronic fistulas. Confirm with your provider.
What are the signs of complications post-fistulotomy?
Excessive bleeding, fever, severe pain, or difficulty controlling bowel movements require immediate medical attention.
Can fistulas recur after fistulotomy?
Recurrence is uncommon (2–10%) with proper surgery, but risks are higher in complex fistulas or Crohn’s disease.
What lifestyle changes are needed post-fistulotomy?
Maintain a high-fiber diet, stay hydrated, avoid straining during bowel movements, and practice good anal hygiene to prevent recurrence.
Conclusion
.
Looking for Best Hospitals for Fistulotomy
Note: we are not promoting any hospitals
We do not promote any hospitals. All details are sourced from Google and hospital websites. Please verify independently. Start with your surgery—here’s the list of government, budget, and superspecialty hospitals accredited by the Department of Health (DOH), Philippine Health Insurance Corporation (PhilHealth), and Joint Commission International (JCI)
- click on your city and schedule your surgery now done in good hands.
| City | Minimum Price (₱) | Maximum Price (₱) |
|---|---|---|
|
Angeles City |
|
|
|
Antipolo |
|
|
|
Bacolod |
|
|
|
Bacoor |
|
|
|
Baguio |
|
|
|
Butuan |
|
|
|
Cagayan de Oro |
|
|
|
Caloocan |
|
|
|
Cebu City |
|
|
|
Dasmariñas |
|
|
|
Davao City |
|
|
|
General Santos |
|
|
|
General Trias |
|
|
|
Iligan |
|
|
|
Iloilo City |
|
|
|
Las Piñas |
|
|
|
Makati |
|
|
|
Malolos |
|
|
|
Manila |
|
|
|
Muntinlupa |
|
|
|
Parañaque |
|
|
|
Pasay |
|
|
|
Pasig |
|
|
|
Puerto Princesa |
|
|
|
Quezon City |
|
|
|
San Fernando |
|
|
|
San Jose del Monte |
|
|
|
Taguig |
|
|
|
Valenzuela |
|
|
|
Zamboanga City |
|
|
Disclaimer
This information is sourced from open platforms and is for general awareness only. Costs may vary based on individual cases. Please consult a qualified doctor for medical advice and explore options within your budget before deciding on the procedure.