Do You Really Need Surgery for Anal Fistulas? Expert Insights

Is surgery always necessary for anal fistulas?

Hello Dr.
Ke,
Due to a busy lifestyle before the New Year, I developed an anal abscess during the holiday.
After the New Year, a doctor used a syringe to drain the pus and prescribed antibiotics.
It has been over two weeks (I am still taking the medication, which is expected to last three weeks), and I can now engage in normal activities.
There is no external opening, and the wound has healed.
Aside from a slight sensation of a subcutaneous cyst, I feel no discomfort, and there is no pus discharge.
My bowel movements are normal.

I have seen two doctors; one mentioned that he believes there is still an issue and that if it recurs, surgery will be necessary.
The other doctor also indicated that there may be a need for two or three surgeries, as the previous doctor mentioned that surgery could also lead to recurrence.
I would like to ask the doctor:
1.
Is surgery absolutely necessary?
2.
If surgery is not performed, is there a possibility of developing complex fistulas, making it more difficult to achieve a complete cure in the future?
3.
If I experience a recurrence after stopping the medication, will surgery at that point increase the likelihood of recurrence postoperatively?
I am truly at a loss and would appreciate your guidance amidst your busy schedule.
Thank you!

lanse, 30~39 year old female. Ask Date: 2017/02/20

Dr. Ke Fangxu reply Surgery

1.
If an anal fistula is not surgically treated, it will not be cured, and symptoms will recur.

2.
Yes.

3.
Medication is used to control infection symptoms, and it is not related to the recurrence of surgery.
The likelihood of recurrence is more closely related to the complexity of the fistula.

Reply Date: 2017/02/20

More Info

When it comes to anal fistulas, the decision to undergo surgery is often a complex one that involves weighing the risks and benefits. An anal fistula is an abnormal connection between the anal canal and the skin surrounding the anus, often resulting from an infection that leads to the formation of an abscess. Your experience with an anal abscess and subsequent treatment with antibiotics is quite common, and it appears that your symptoms have improved significantly. However, the concern about the potential for a fistula to develop is valid.

1. Is Surgery Necessary?
Surgery is often recommended for anal fistulas, especially if they are symptomatic or if there is a risk of recurrence. The primary goal of surgery is to eliminate the fistula and prevent future complications. While some fistulas may close on their own, many do not, and if left untreated, they can lead to chronic discomfort, recurrent infections, and complications such as abscess formation. In your case, since two doctors have indicated the possibility of a fistula, it would be prudent to have a thorough evaluation, possibly including imaging studies, to confirm the diagnosis.

2. Risk of Complicated Fistulas:
If a fistula is indeed present and not treated, there is a risk that it could become more complex over time. Complicated fistulas can involve multiple tracts and may be more challenging to treat surgically. This complexity can lead to a higher likelihood of recurrence and may require more extensive surgical intervention. Therefore, if there is a suspicion of a fistula, it is generally advisable to address it sooner rather than later to avoid complications.

3. Recurrence and Surgery:
If you stop taking antibiotics and experience a recurrence of symptoms, surgery may indeed be necessary at that point. However, it is important to note that the timing of surgery can influence the outcome. If surgery is performed while the tissue is still inflamed or infected, it may increase the risk of complications and recurrence. On the other hand, if the fistula is treated surgically when the surrounding tissue is healthy, the chances of a successful outcome are significantly improved.

In summary, while surgery for anal fistulas is often necessary, the decision should be made based on a thorough evaluation by a colorectal surgeon. They can assess the specifics of your case, including the type and complexity of the fistula, and recommend the best course of action. If surgery is indicated, it is typically performed as an outpatient procedure, and recovery can vary depending on the complexity of the fistula and the surgical technique used.

In the meantime, it is essential to maintain good hygiene, monitor for any signs of recurrence, and communicate openly with your healthcare provider about any concerns you may have. If you have further questions or uncertainties, consider seeking a second opinion from a specialist in colorectal surgery, as they can provide tailored advice based on your individual situation.

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