Fistulotomy is one of the surgical procedures used to treat fistulas. Fistulas treated with fistulotomy have a very high cure rate, even close to 100%.
A fistula is an abnormally connected channel between two organs. An example of a fistula that is commonly encountered is an anal fistula, which is the formation of an abnormal channel between the anus and the skin around the anus.
Anal fistulas can be caused by a number of things, but they are usually caused by an infection that develops into a pus-filled lump in the tissue around the anus.
Anal fistula will not heal on its own. Therefore, it requires treatment by a doctor. If an anal fistula is not treated properly, a number of long-term and potentially life-threatening complications can occur, such as full-body infection (sepsis) and anal cancer.
To treat anal fistula, one of the treatment methods that doctors can do is fistulotomy.
Purpose of Fistulotomy Surgery
The goal of fistulotomy surgery is to drain pus and fluid from the anal fistula. In this operation, the skin and muscles of the anal fistula tract that have been dissected will also be left open to allow natural healing from within.
Compared to other surgical procedures for treating anal fistulas, fistulotomy is a fairly simple procedure and has a low risk of causing muscle injury around the anus (anal sphincter), so that these muscles can still function properly after surgery.
Fistulotomy can also be used to treat various types of fistulas, apart from anal fistulas. In fact, when used for the right indications, fistulotomy can provide a cure rate close to 100%.
Indications for Fistulotomy Operation
Fistulotomy surgery is mainly used to treat simple or mild anal fistulas, namely anal fistulas that are low (close to the anal sphincter muscle) and have a single hole in the skin around the anus.
Fistulotomy surgery is not performed in complex or severe anal fistula conditions. Anal fistulas are complex if:
- Anal fistula is located above the anal sphincter muscle (where there is more muscle)
- Anal fistula has many holes in the skin around the anus
- Anal fistulas occur due to radiation therapy or inflammatory bowel disease
- Anal fistula is connected to the female genital tissue
In addition to complex anal fistulas, fistulotomy is also not performed in the condition of recurrent anal fistulas.
Fistulotomy Operation Preparation
To determine whether fistulotomy surgery is the right treatment for your anal fistula, the doctor will first perform a digital rectal examination to estimate the size and location of the anal fistula. To make the results of the examination more accurate, the doctor may also run other tests, such as:
Magnetic resonance imaging (MRI)
This imaging test uses radio waves and strong magnets to produce detailed images of the fistula tract, anal sphincter muscle, and other structures of the pelvic floor.
Endoscopic ultrasound
This examination uses a high-frequency sound-producing device that is inserted into the anus to produce clear and detailed images of the fistula, anal sphincter muscle, and surrounding tissue.
Fistulography
In fistulography, dye (contrast) is inserted through the fistula opening in the skin around the anus, then X-rays are taken to identify the shape and size of the fistula tract.
From the results of these examinations, the doctor will decide whether a fistulotomy is the most appropriate treatment method for your anal fistula.
In terms of preparation before surgery, doctors generally will not give laxatives to clean the intestines of remaining feces. However, if needed, doctors usually give a rectal laxative (enema) once in the morning before surgery.
The doctor will also advise you to stop eating at midnight before the operation. However, you are still allowed to drink a small amount of water up to 4 hours before surgery. After that, you are advised not to eat and drink at all.
Fistulotomy Operation Procedure
If your anal fistula is small and low in position, your doctor may perform a surgical procedure using only local anesthesia. But if the fistula is large, you may need to undergo surgery under general or general anesthesia.
During surgery, the doctor will position your body based on the location of the fistula. Your doctor may position you on your stomach, on your stomach with your midsection bent into an upside-down “V”, or on your back with your legs bent at the hips and knees at a 90-degree angle.
During the operation, the doctor will make an incision from the fistula opening. The anus will be opened with a special tool, then the fistula tract is opened with a scalpel. The procedure is carried out with great care to avoid damage to the anal sphincter muscle.
After the fistula tract is open, the base of the fistula is cured (scraped), then the wound is left open to heal by itself.
If necessary, the doctor will perform a marsupialization procedure, in which the edges of the wound are sutured to the surrounding tissue so that the wound remains open and can increase the flow of fluid out, reduce bleeding, and reduce pain that may arise.
When the operation is complete, the wound is closed and bandaged with gauze to keep it clean. Fistulotomy surgery can take from 30 minutes to 1 hour, depending on the size and location of the anal fistula.
Complications of Fistulotomy Surgery
Like any surgical procedure, fistulotomy can also cause complications. Some complications can occur immediately after surgery, while others appear only a few weeks or months after surgery.
Complications that can arise after surgery include:
- Heavy bleeding or excessive discharge from the surgical wound
- Difficulty urinating
- Difficulty defecating
Complications that are less common and generally appear a few weeks or months after surgery include:
- Recurrence of anal fistula
- Can't hold bowel movements
- Narrowing of the anus, so that bowel movements need to be pushed hard enough
- Wounds that don't heal (after 12 weeks)
It is important to remember that anal fistulas do not heal on their own. Therefore, if you experience symptoms of an anal fistula, such as anal pain, irritated anal skin, or bleeding during bowel movements, consult your doctor further to confirm your condition.
If you are diagnosed with an anal fistula, your doctor will perform a follow-up examination to decide if your condition can be treated with a fistulotomy procedure.
Written by:
Sonny Seputra, M.Ked.Klin, Sp.B, FINACS
(Surgeon Specialist)