Fistula Surgery: Risks, Delays, and Management Options

Fistula surgery issues

Hello Doctor: About a week ago, I discovered a lump near my anus, which causes pain when walking, sitting, or riding a bike.
The next day, it burst and drained pus, which alleviated the pain somewhat.
I later visited a clinic, and the doctor diagnosed it as a fistula, stating that surgery is necessary for a complete cure.
The doctor also mentioned that if I feel it won't affect me, I could choose not to have surgery, but there is a 3% chance it could develop into anal cancer.
I would like to ask the doctor: 1.
If I wish to postpone the surgery until March next year, is there a possibility of it worsening into a complex fistula or even cancer? 2.
Given the external opening is very close to the anus, is there a risk of incontinence due to surgical complications? (It's located near the soft, wrinkled area around the anus.) 3.
If I decide not to have surgery for now, what methods can I use to delay its worsening or prevent infection? Thank you very much for taking the time to respond, I appreciate it.

A Long, 20~29 year old female. Ask Date: 2017/11/04

Dr. Ke Fangxu reply Surgery

1.
I have not heard of anal fistulas turning into malignant tumors, but delaying surgery for a few months should not pose a significant risk.

2.
Generally, an external opening that is farther from the anal opening is more likely to result in incontinence because more of the sphincter muscle may be cut during surgery.
An opening closer to the anal opening should cause less damage to the sphincter muscle.

3.
If surgery is temporarily deferred, oral antibiotics can be used to manage symptoms, but this is not a long-term solution.

Reply Date: 2017/11/04

More Info

Fistula surgery is a significant medical procedure that addresses the complications arising from anal fistulas, which can be painful and lead to further health issues if left untreated. Based on your situation, here are the answers to your questions, along with some additional insights into the management of anal fistulas.

1. Delay in Surgery and Risk of Complications: If you choose to postpone surgery until March, there is indeed a risk that the fistula could worsen. While not every case will lead to complications, there is a potential for the fistula to develop into a more complex type, which may involve more extensive tissue and possibly lead to further complications, including the risk of malignancy. The 3% risk of developing anal cancer is a concern, especially if the fistula remains untreated for an extended period. Chronic inflammation and irritation from the fistula can contribute to cellular changes that may increase cancer risk. Therefore, while it is possible to delay surgery, it is essential to monitor the condition closely and consult with your healthcare provider regularly.

2. Surgical Risks and Incontinence: The proximity of the fistula to the anal sphincter does raise valid concerns regarding the risk of incontinence post-surgery. Surgeons are trained to navigate these delicate structures carefully, but there is always a risk of nerve damage or disruption to the sphincter mechanism during the procedure. The likelihood of this occurring depends on the complexity of the fistula and the surgical technique used. Discussing these concerns with your surgeon can help you understand the specific risks associated with your case and the measures they will take to minimize them.

3. Conservative Management and Prevention of Infection: If you decide to delay surgery, there are several conservative measures you can take to manage the condition and reduce the risk of infection or worsening symptoms. These include:
- Hygiene: Keeping the area clean is crucial. Gently wash the area with mild soap and water, and consider using sitz baths to soothe the area and promote healing.

- Diet: A high-fiber diet can help prevent constipation, which can exacerbate symptoms. Staying hydrated is also essential.

- Pain Management: Over-the-counter pain relievers can help manage discomfort. However, consult your doctor before taking any medication.

- Monitoring Symptoms: Keep an eye on any changes in symptoms, such as increased pain, swelling, or discharge. If you notice any concerning changes, seek medical attention promptly.

In conclusion, while it is possible to delay surgery for an anal fistula, it is essential to weigh the risks of complications, including the potential for cancer and the impact on your quality of life. Regular follow-ups with your healthcare provider can help you make informed decisions about your treatment options. If you experience any new symptoms or significant changes in your condition, do not hesitate to seek medical advice. Your health and well-being should always be the priority.

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