General Information

DEFINITION--Removal of an anal fistula, an abnormal tract extending from inside the rectum to the skin outside of the anus.

BODY PARTS INVOLVED--Rectum; skin and underlying tissue around the rectum and anus.

REASONS FOR SURGERY

• Repeated abscesses in the anal and rectal areas.
• Chronic drainage from a fistula.

SURGICAL RISK INCREASES WITH

• Stress.
• Poor nutrition.
• Recent illness.
• Obesity.
• Smoking.
• Use of drugs such as: antihypertensives; muscle relaxants; tranquilizers; sleep inducers; insulin; sedatives; beta-adrenergic blockers; or cortisone.
• Use of mind-altering drugs, including: narcotics; psychedelics; hallucinogens; marijuana; sedatives; hypnotics; or cocaine.

What To Expect

WHO OPERATES--General surgeon or proctologist.

WHERE PERFORMED--Outpatient surgical facility or hospital.

DIAGNOSTIC TESTS

• Before surgery: x-rays of lower gastrointestinal tract; colonoscopy (See Glossary).
• After surgery: Blood studies.

ANESTHESIA--General anesthesia by injection and inhalation with an airway tube placed in the windpipe.

DESCRIPTION OF OPERATION

• An incision is made in the skin around the rectum. Abscesses are drained, if necessary.
• The fistula is located with a delicate probe, cut free of connective tissue and removed.
• The space left by the removed fistula is packed with medicated gauze. A bandage is applied to control bleeding.
• The surgical wound is left open to heal from inside out.

POSSIBLE COMPLICATIONS

• Excessive bleeding.
• Surgical-wound infection.
• Slow healing or recurrence.

AVERAGE HOSPITAL STAY--0-3 Days.

PROBABLE OUTCOME--Expect complete healing without complications in 4 to 5 weeks for small fistulas and up to 16 weeks for deeper ones.

Postoperative Care

> Use an electric heating pad, a heat lamp or a warm compress to relieve surgical--

wound pain.

• Take warm baths as often as needed to relieve discomfort. > Move and elevate legs often while confined to bed to decrease the likelihood of deep-vein blood clots. > Change bandages or sanitary pads 4 to 5 times a day or as directed by your doctor. > Clean the rectal area with soap and water after bowel movements.

> You may use non--prescription drugs, such as acetaminophen, for minor pain.

> To help recovery and aid your well--

being, resume daily activities, including work, as soon as you are able.

• Avoid vigorous exercise for 6 months after surgery. > Resume driving 1 week after returning home. > Resume sexual relations when your doctor determines that healing is complete.

DIET--Clear liquid diet until the gastrointestinal tract functions again. Then eat a well--balanced diet to promote healing, if your doctor does not prescribe a special diet. Increase fiber and fluid intake to prevent constipation.

Call Your Doctor If

> Pain, swelling, redness, drainage or bleeding increases in the surgical area.