Fistula Surgery: Managing Concerns and Recovery Tips

Anal fistula, post-fistulotomy?

Hello Dr.
Chang,
Last week, I underwent an anal fistula surgery in the hospital.
I was aware before the surgery that I had two fistulas, but after the operation, when I touched the skin around my anus, I found that there was still a small portion of the fistula that had not been removed.
During my follow-up visit today, I asked the doctor why I could still feel the fistula, and he did not deny it.
When I inquired whether the remaining portion inside me was a branch, he confirmed it was a branch and stated that only the main tract was removed during the surgery.
He mentioned that the main tract was cut without damaging the sphincter and advised me to use suppositories to harden the branch.
I can only feel a very short segment, less than a centimeter, and I am unsure about its depth.
While I choose to trust the doctor's expertise, I still have concerns.
Are there any clinical cases where only the main tract was removed without addressing the branches, resulting in a low recurrence rate? I am worried that my main tract wound may recur soon after healing.
1.
I only had the main tract removed, and the branch remains.
Do you think the surgeon's decision was appropriate?
2.
Regarding pain medication, if I am not in pain, can I stop taking it?
3.
In terms of diet, the hospital advised me to maintain a normal diet without restrictions.
Is this accurate?
4.
How long after the surgery can I use body wash while bathing?
5.
What can I do to promote healing of the internal opening? Should I focus on nutrition or allow it to heal gradually to benefit the wound and reduce the recurrence probability?
6.
Given that the branch remains, I am genuinely worried.
What preventive measures can I take to avoid recurrence?
Thank you, Dr.
Chang!

Mr. Li, 20~29 year old female. Ask Date: 2021/12/27

Dr. Zhang Shuhao reply Surgery

Complex or higher-level fistula surgeries are challenging and can easily damage the external anal sphincter.
Therefore, some physicians may take a more conservative approach, focusing on alleviating symptoms and preventing recurrence.
Typically, a thorough excision of the internal opening is less likely to recur.
Pain relief medication may not be necessary if there is no pain, and it is advisable to minimize the intake of irritating foods, avoid diarrhea, and refrain from smoking.
Showering with body wash is acceptable at any time.
It is difficult for the internal opening to heal on its own, but reducing diarrhea and maintaining local cleanliness can lower the risk of recurrence.
If there are signs of redness, swelling, heat, or pain, medical evaluation is necessary.
Wishing you a speedy recovery.

Reply Date: 2021/12/27

More Info

Understanding fistula surgery and the recovery process can be a source of anxiety for many patients. It's important to address your concerns with accurate information and reassurance based on medical knowledge.

1. Surgical Considerations: In fistula surgery, the primary goal is to remove the main tract (the "主管") of the fistula while preserving surrounding structures, including the sphincter muscles. It is not uncommon for surgeons to leave small branches (the "支管") intact if they believe that removing them could risk damaging the sphincter or lead to complications. The rationale behind this approach is to minimize the risk of incontinence while still addressing the primary issue. There are indeed cases in clinical practice where only the main tract is removed, and the patient experiences a low recurrence rate. However, the success of this approach can depend on various factors, including the complexity of the fistula and the individual patient's anatomy.

2. Pain Management: If you are not experiencing pain, it is generally safe to discontinue pain medication. Pain is a signal from your body indicating that something may need attention. If you feel comfortable and have no pain, you can stop taking the medication. However, if you experience any discomfort later, you should consult your doctor.

3. Dietary Recommendations: After fistula surgery, a normal diet is often encouraged to help promote healing. However, it is advisable to consume a balanced diet rich in fiber to prevent constipation, which can strain the surgical site. While there may not be strict dietary restrictions, avoiding overly spicy or irritating foods can be beneficial in the early recovery phase.

4. Hygiene Practices: Regarding bathing, it is typically recommended to avoid using harsh soaps or body washes directly on the surgical site for at least two weeks post-surgery. Gentle cleansing with mild soap and water is usually sufficient. Always follow your surgeon's specific instructions regarding wound care and hygiene.

5. Wound Healing: To promote healing of the internal opening (the "內口"), maintaining a nutritious diet is essential. Foods rich in vitamins A, C, and E, as well as zinc, can support tissue repair. Staying hydrated and consuming fiber-rich foods can also help ensure smooth bowel movements, reducing strain on the surgical site.

6. Preventing Recurrence: To minimize the risk of recurrence, it is crucial to follow your surgeon's post-operative care instructions closely. Regular follow-up appointments are important for monitoring healing and addressing any concerns early. If you notice any unusual symptoms, such as increased pain, discharge, or changes in bowel habits, contact your healthcare provider immediately.

In summary, while it is natural to have concerns after surgery, understanding the rationale behind your treatment and following your doctor's advice can help alleviate anxiety. Trust in your healthcare team and maintain open communication with them regarding your recovery. If you have further questions or concerns, don't hesitate to reach out to your surgeon for clarification and support.

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