the Necessity of Fistula Surgery: A Patient's Perspective

Fistula surgery

Previously, I experienced severe anal itching and visited a proctology clinic before the end of December.
The doctor diagnosed me with a fistula but mentioned that my condition was relatively mild (seemingly very minor) and only prescribed anti-inflammatory medication.
I was advised to take care of my health, and after more than a month, I noticed significant improvement, with only occasional mild itching.
However, when I intentionally apply pressure near the anus, I feel pain.
I have researched extensively online, and many articles suggest that definitive treatment is better to prevent recurrence and worsening of the condition.
However, the clinic doctor believes I am still young and does not want to perform surgery.
Given this situation, what is the necessity of surgery for an anal fistula?

Rui Rui, 20~29 year old female. Ask Date: 2017/02/03

Dr. Ke Fangxu reply Surgery

The anal fistula indeed requires surgical excision for a complete cure; however, this type of surgery cannot be performed in a clinic and must be done in a hospital by a specialist under anesthesia.
Therefore, please first visit a colorectal surgery outpatient clinic for a physician to evaluate and confirm the diagnosis, and then discuss the necessity of surgery with the doctor.

Reply Date: 2017/02/03

More Info

When considering the necessity of fistula surgery, particularly in the context of an anal fistula, it's essential to weigh the symptoms, the potential for complications, and the overall impact on quality of life. An anal fistula is an abnormal connection between the anal canal and the skin surrounding the anus, often resulting from an infection or abscess.
In your case, it seems that you have experienced significant discomfort, including itching and occasional pain, but your symptoms have improved with conservative treatment, such as anti-inflammatory medication and lifestyle adjustments. This is a positive sign, as it indicates that your condition may not be severe at this moment. However, the concern about the potential for recurrence or worsening of the condition is valid.

When is Surgery Necessary?
1. Persistent Symptoms: If symptoms persist despite conservative treatment, surgery may be warranted. This includes ongoing pain, recurrent infections, or significant discomfort that affects daily activities.

2. Risk of Complications: If there is a risk of complications, such as abscess formation or worsening of the fistula, surgical intervention may be necessary to prevent further issues.

3. Quality of Life: If the symptoms significantly impact your quality of life, even if they are not severe, surgery might be considered to provide long-term relief and prevent future recurrences.

4. Age and Health Considerations: While your doctor may have reservations about performing surgery due to your age, it’s important to note that younger patients can often recover more quickly from surgical procedures. However, the decision should also consider your overall health and any underlying conditions.

Surgical Options
If surgery is deemed necessary, there are several approaches that can be taken:
- Fistulotomy: This is the most common procedure, where the fistula is opened and allowed to heal from the inside out. This method has a high success rate but may require time for recovery.

- Seton Placement: In cases where the fistula is complex, a seton (a piece of surgical thread) may be placed to help drain the fistula and promote healing over time.

- Flap Procedures: For more complicated fistulas, a flap procedure may be used to cover the internal opening of the fistula.

Risks and Considerations
Every surgical procedure carries risks, including infection, bleeding, and complications related to anesthesia. Additionally, there is a risk of incontinence, particularly with more extensive surgeries. However, these risks must be balanced against the potential benefits of surgery, including the resolution of symptoms and prevention of future complications.

Conclusion
In summary, the necessity of fistula surgery should be based on a thorough evaluation of your symptoms, the potential for complications, and your overall quality of life. If your symptoms are manageable and not significantly impacting your daily activities, conservative treatment may be appropriate. However, if you experience recurrent issues or if your symptoms worsen, it may be time to revisit the option of surgical intervention. It’s crucial to maintain open communication with your healthcare provider, expressing your concerns and preferences, to arrive at a decision that aligns with your health goals and lifestyle.

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