Post-Surgery Anal Fistula: Pain, Healing, and Treatment Options

Post-operative wound after fistula surgery?

Hello Doctor: After undergoing surgery for a fistula and mixed hemorrhoids on December 28, 2018, I often experience swelling and pain when pressing on the area where the fistula was located.
Upon examination, it was found that there is still a small wound inside the anus that has not healed.
During this period, I have consulted 11 doctors.
Some said it is simply a surgical wound that is healing slowly and requires ongoing care, while others suggested that the fistula was not properly addressed and that I need to undergo another surgery.
I would like to ask: 1.
Are there any imaging techniques, such as X-rays, CT scans, or MRIs, that can confirm whether it is a fistula or just a simple wound? 2.
I am concerned about the potential complications from another surgery; are there any methods to minimize these complications? 3.
Can you recommend any medical institutions in Taiwan that are experienced in handling these issues (I live in Kaohsiung, but I am willing to travel anywhere in Taiwan), or could I consult Dr.
Ke for assistance? 4.
I inquired at a clinic, and they mentioned that self-funded microwave needle therapy could help reduce complications; do you think this would be beneficial?

Xiao Huang, 40~49 year old female. Ask Date: 2019/06/02

Dr. Ke Fangxu reply Surgery

1.
Anal fistulas can be evaluated using fistulography to determine their course; however, this type of examination is typically available only at larger hospitals.
Magnetic resonance imaging (MRI) can also be used, but health insurance may not cover it, and the diagnostic accuracy may be lower.

2.
If there is a recurrence, surgical intervention will be necessary again for a definitive cure.
As long as the surgery does not disrupt a significant portion of the sphincter muscle, there should not be major complications.
For detailed information, it is advisable to discuss and assess with the surgeon.
3.
Generally, consulting a colorectal surgeon will not make a significant difference; I personally do not have any specific recommendations.
4.
I do not personally recommend this type of treatment.
Although it does not require extensive surgical incision, the recurrence rate is relatively high.
I suggest seeking opinions from multiple doctors for better guidance.

Reply Date: 2019/06/02

More Info

Post-surgery complications, especially after procedures like anal fistula surgery, can be quite challenging and distressing for patients. It’s essential to address your concerns systematically to provide clarity and guidance on managing your situation.

1. Diagnostic Imaging: To determine whether you have a residual fistula or if it’s simply a slow-healing surgical wound, imaging studies can be quite helpful. While traditional X-rays are not effective for soft tissue evaluation, MRI (Magnetic Resonance Imaging) is often the gold standard for assessing anal fistulas. MRI can provide detailed images of the anal canal and surrounding tissues, helping to identify any remaining fistulous tracts or abscesses. CT scans can also be useful, but MRI is generally preferred in this context due to its superior soft tissue contrast.

2. Managing Post-Surgical Complications: Concerns about potential complications from a second surgery are valid. To minimize the risk of complications, it’s crucial to ensure that any subsequent procedure is performed by a skilled surgeon experienced in anal surgery. Preoperative assessments, including imaging, can help plan the surgery more effectively. Post-surgery, adhering to proper wound care, maintaining good hygiene, and following your surgeon's advice on diet and activity can significantly aid in healing and reduce the risk of complications. Additionally, discussing pain management options with your healthcare provider can help alleviate discomfort during the healing process.

3. Recommended Medical Facilities: In Taiwan, there are several reputable medical institutions known for their expertise in colorectal surgery. National Taiwan University Hospital and Chang Gung Memorial Hospital are two of the leading hospitals with specialized departments for colorectal conditions. You may also consider seeking a consultation with a colorectal surgeon who has a strong background in managing complex anal conditions. If you are looking for specific recommendations for doctors, it would be best to consult local medical boards or patient forums for personal experiences and referrals.

4. Alternative Treatments: Regarding the use of microwave needle therapy, this is a relatively new approach that some practitioners may offer for managing pain and promoting healing in soft tissue injuries. While there is some evidence supporting the use of such therapies for various conditions, it’s essential to approach these options with caution. Discussing this with your healthcare provider is crucial to ensure that it aligns with your treatment plan and does not interfere with your recovery.

In summary, your situation requires careful evaluation and management. Seeking a second opinion from a specialized colorectal surgeon, utilizing appropriate imaging techniques, and adhering to recommended post-operative care can significantly improve your healing process. Always communicate openly with your healthcare providers about your concerns and preferences to ensure that you receive the best possible care tailored to your needs.

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