Challenges in Healing After Multiple Anal Fistula Surgeries: A Case Study

It seems that there is poor healing after multiple surgeries for anal fistula?

Hello Dr.
Ke: Initially, in January 2015, I developed a hard lump and pain near my anus.
After consulting a doctor, I was treated with antibiotics for nearly two months, but the symptoms recurred.
Consequently, I underwent two fistula drainage surgeries at Renai Hospital in May and September 2015.
After the surgeries, I developed abscesses around the anus that discharged secretions.
In January 2016, I had a third surgery at Yadong Hospital.
The doctor there mentioned that the fistula was not fully excised near the anal area, making it impossible to eradicate.
This time, the surgery was extensive and deep, and a plastic ring was placed (which was removed after two follow-up visits).
The wound was significant and was allowed to heal naturally.
It has been nearly six months now; other areas have healed, but this deep wound still requires daily cleaning with a fine cotton swab as per the doctor's instructions.
Although the depth has reduced from about 5-6 cm to around 3 cm, I have recently noticed that there is still discharge and blood seeping out.
Additionally, there is still pain when pressing on the tissue around this small wound.
Could this be a sign of fistula recurrence? I wonder why fistulas are so difficult to eradicate; is it due to the initial delay in treatment leading to a complex fistula? Thank you for your careful reading and response.
^^

A-Dang, 50~59 year old female. Ask Date: 2016/07/13

Dr. Ke Fangxu reply Surgery

The term "complex fistula" is used because it is difficult to cure and the surgery is challenging.
Based on your description, it seems likely that there has been a recurrence.
If multiple surgeries have already been performed, it may be advisable to consider medical treatment first.
Please return to your primary physician for a follow-up appointment to discuss the next steps in your treatment plan.

Reply Date: 2016/07/13

More Info

The challenges associated with healing after multiple anal fistula surgeries can be significant and multifaceted. Anal fistulas are abnormal connections between the anal canal and the skin, often resulting from an infection in the anal glands. When these fistulas become chronic, they can lead to recurrent infections, pain, and the need for multiple surgical interventions.
In your case, it appears that you have undergone three surgeries to address the anal fistula, with varying degrees of success. The persistence of symptoms such as discharge and bleeding, along with the pain you are experiencing, raises concerns about the possibility of a fistula recurrence. This situation is not uncommon, especially in cases where the fistula is complex or has been present for an extended period.

Several factors can contribute to the difficulty in healing and the recurrence of anal fistulas:
1. Complexity of the Fistula: Some fistulas are more complicated than others, involving multiple tracts or being located in areas that are difficult to access surgically. If the fistula extends into the anal sphincter or involves surrounding tissues, it may be more challenging to achieve complete healing.

2. Delayed Treatment: As you mentioned, if treatment is delayed, the fistula can become more entrenched and complex, making surgical management more difficult. Chronic inflammation and scarring can also complicate the healing process.

3. Infection: Persistent infection can hinder healing. Even after surgery, if there is residual infection or if the wound becomes infected, it can lead to ongoing symptoms and complications.

4. Wound Care: Proper wound care is crucial for healing. It appears you are following your doctor's advice by cleaning the wound regularly, but if there is any deviation from the recommended care, it could impact healing.

5. Underlying Conditions: Certain medical conditions, such as Crohn's disease or diabetes, can affect healing and increase the likelihood of recurrence. If you have any underlying health issues, they should be managed appropriately.

6. Surgical Technique: The success of fistula surgery can also depend on the surgical technique used. Some techniques may have higher success rates than others, and the choice of technique can influence the likelihood of recurrence.

Given your current symptoms, it is essential to follow up with your healthcare provider. They may recommend imaging studies, such as an MRI or ultrasound, to assess the fistula's status and determine if there is a recurrence or if there are other underlying issues contributing to your symptoms.
In terms of management, if a recurrence is confirmed, further surgical intervention may be necessary. Options may include more extensive surgery to ensure complete removal of the fistula tract or the use of advanced techniques such as seton placement, which allows for gradual healing while keeping the fistula open.

Additionally, pain management and addressing any discomfort you are experiencing are important aspects of your care. Your healthcare provider may recommend medications or other therapies to help alleviate pain and improve your quality of life during the healing process.

In conclusion, healing from anal fistula surgeries can be challenging, particularly in cases of complex or recurrent fistulas. Close monitoring, appropriate wound care, and timely follow-up with your healthcare provider are crucial for achieving the best possible outcome. If you have concerns about your healing process or the possibility of recurrence, do not hesitate to reach out to your healthcare team for guidance and support.

Similar Q&A

Post-Surgery Recovery: Understanding Anal Fistula Healing Process

Hello Dr. Ke, I had a bit of a lapse in memory around the end of June when I developed an "anal abscess" due to frequent wiping from diarrhea. Initially, I was unaware of the condition and visited a small clinic where I was prescribed painkillers and anti-inflammatory m...

Dr. Ke Fangxu reply Surgery
If an anal abscess is left untreated for too long, there is a higher chance that it will develop into a fistula. This type of fistula is generally more complex to manage and has a higher likelihood of recurrence. Currently, you have undergone drainage of the abscess and a fistulo...

Understanding Anal Fistula Surgery: Addressing Post-Operative Concerns

Hello Dr. Ke, my father has developed something resembling acne near his anus, which has repeatedly become infected and ruptured. The doctor diagnosed it as a fistula and he underwent fistula surgery a week ago. However, during the follow-up appointment one week post-surgery, ano...

Dr. Ke Fangxu reply Surgery
The National Health Insurance does not stipulate that an anal fistula surgery can only remove one site at a time. It is likely that another site was not detected during the initial surgery and therefore was not removed. A second surgery may be unavoidable. However, it may be bett...

Challenges in Healing Anal Fistula Post-Surgery: A Patient's Journey

Hello, Doctor! Here is the background: My mother was diagnosed with rectal cancer around 2019 (very close to the anus). The first physician mentioned that the tumor was too close to the anal sphincter, which would necessitate a permanent colostomy for bowel movements. We found th...

Dr. Ke Fangxu reply Surgery
1. Low rectal cancer, after radiation therapy and surgery, has a high probability of developing a rectovaginal fistula. Once formed, it is difficult to heal because radiation therapy can affect local blood circulation, making the fistula less likely to close. 2. The discharge m...

Effective Strategies for Treating Chronic Anal Fistulas

Hello doctor, I have a severe fistula. Over the past few years, I have consulted several doctors and undergone multiple surgeries, but I still have recurring abscesses that have not been eradicated. This has been a persistent issue affecting my daily life. Do I need multiple exci...

Dr. Ke Fangxu reply Surgery
Hello: In response to your question, complex anal fistulas are indeed quite challenging. If not completely excised, they can recur. If there are multiple openings on the skin, it becomes a surgeon's nightmare. While it is not impossible to eradicate them in a single surgery,...