Risks of Anal Fistula Surgery: What You Need to Know

Risks of Anal Fistula Surgery

Hello Doctor, I was diagnosed with an anal fistula around October this year.
However, I have been quite busy during the semester and plan to have the surgery during the winter break.
I would like to ask if the surgery to remove the anal fistula carries a significant risk of fecal incontinence? My family has been advising against the surgery because they are quite fearful.
Also, how long does it typically take to recover after the surgery? Thank you, Doctor.

Niming, 20~29 year old female. Ask Date: 2020/12/15

Dr. Ke Fangxu reply Surgery

Surgery for anal fistulas does not cause incontinence; this is a misconception that has been perpetuated over time.
If a simple fistula is not treated, it may worsen into a complex fistula, which most physicians are reluctant to manage.
Complete healing of the surgical wound typically takes about a month.
For a young patient like you, I recommend undergoing surgical treatment.
If an anal fistula is not addressed promptly while it is still simple, it can lead to recurrent issues and worsening conditions throughout a long life.

Reply Date: 2020/12/15

More Info

When considering surgery for an anal fistula, it's essential to understand both the risks involved and the recovery process. An anal fistula is an abnormal connection between the anal canal and the skin surrounding the anus, often resulting from an infection or abscess. Surgical intervention is typically recommended to prevent recurrent infections and complications.

Risks of Anal Fistula Surgery
1. Incontinence: One of the primary concerns with anal fistula surgery is the risk of fecal incontinence. This risk can vary depending on the complexity of the fistula and the surgical technique used. In general, the risk of significant incontinence is relatively low, especially when performed by an experienced surgeon. However, it is crucial to discuss your specific case with your healthcare provider to understand your individual risk factors.

2. Infection: As with any surgical procedure, there is a risk of infection at the surgical site. Proper postoperative care and hygiene can help mitigate this risk.

3. Recurrence: There is a possibility that the fistula may recur after surgery. This is more common in complex fistulas or those associated with underlying conditions such as Crohn's disease.

4. Pain and Discomfort: Postoperative pain is common, and while it can usually be managed with medications, some patients may experience prolonged discomfort.

5. Narrowing of the Anal Canal: In some cases, surgery can lead to scarring that narrows the anal canal, which may require further intervention.

Recovery Process
The recovery time after anal fistula surgery can vary based on the surgical technique used and the individual’s overall health. Generally, patients can expect the following:
- Initial Recovery: Most patients can return home the same day or the day after surgery. However, you may need to take it easy for a few days. Pain management will be an essential part of your recovery, and your doctor will likely prescribe pain relief medications.

- Activity Restrictions: It is advisable to avoid strenuous activities, heavy lifting, or prolonged sitting for at least a week or two post-surgery. Gentle walking is encouraged to promote circulation and healing.

- Follow-Up Appointments: Regular follow-up appointments with your surgeon will be necessary to monitor healing and address any complications.

- Full Recovery: While many patients start feeling better within a week or two, complete healing of the surgical site may take several weeks. It is essential to follow your surgeon's postoperative care instructions, including dietary recommendations to prevent constipation, which can strain the surgical site.

Conclusion
While the concerns of your family regarding surgery are valid, it is crucial to weigh the risks of not having the surgery against the potential complications of the fistula itself. If left untreated, anal fistulas can lead to chronic pain, recurrent infections, and other complications. Consulting with a colorectal surgeon who specializes in this area can provide you with a clearer understanding of your specific situation, the risks involved, and the expected outcomes of the surgery. Ultimately, making an informed decision based on a thorough discussion with your healthcare provider will be the best course of action.

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