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A Fistula is an abnormal connection formed between two tracts or organs, and the surgical procedure used to treat it is called Fistulotomy. Uncomplicated perianal fistulas (around the anus) are the most commonly treated fistulas by fistulotomy. These are usually complications of an untreated abscess that develops in the perianal area and breaks through the walls of adjacent structures as it grows. Fistulotomy can effectively open and drain the pus and other fluids to facilitate tissue healing and closure of the abnormal passage. This article will discuss fistulotomy, the procedure involved, and the possible complications that may occur post-surgery
Anal fistulas are abnormal connections that form a passage between the anus internally and the skin externally. These could occur as a complication of untreated perianal abscess or could also develop due to trauma or severe inflammation. It may cause various symptoms like
Fistulotomy treats anal fistulas by opening the passage (fistula) and draining the pus and other fluids to promote healing. It is usually an outpatient procedure performed under general anesthesia (GA). Fistulotomy and fistulectomy are procedures to treat a fistula - the difference from fistulectomy is that in fistulotomy, the surgeon will not remove any tissue, and the two ends of the fistula will be closed and remain attached to the organs, whereas in fistulectomy, the surgeon removes the entire fistula tract.
The purpose of fistulotomy is to drain the pus and the other infected fluids from small and simple fistulas
while keeping them open to promote optimal healing. After a few days, the abnormal passage or
connection between the tracts is closed. Fistulotomy is also recommended to prevent injury to the anal sphincter.
Fistulotomy effectively provides symptomatic relief from pain, bowel incontinence, pus discharge, and other infection-related symptoms (fever, swelling, redness, etc.), thus improving your quality of life. It is further recommended to prevent the progression of malignancy (cancer-forming property) in the existing fistula if left untreated.
Your surgeon will take your history and perform a physical examination. Your medical history will be reviewed to rule out diseases like diabetes (increased blood sugar levels), and heart and lung abnormalities.
A fistulotomy is a minimally invasive (does not involve extensive incisions, bleeding, or trauma to the surrounding structures), and an outpatient procedure (does not require hospitalization). Once you are prepped for the surgery, you will likely be given general anesthesia that will put you to sleep during the entire procedure. Local anesthesia may be used if the fistula is small and just beneath the anal skin. Another form of sedation called MAC (Monitored Anesthesia Care) may be used to induce “twilight sleep" (a condition characterized by insensitivity to pain without the loss of consciousness).
Once the procedure is completed, you will be taken to the recovery room, and your vitals (blood pressure, pulse, heart rate, and urine output) will be monitored until you are fully awake.
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