Healing Time After Anal Fistula Surgery: Key Insights

Healing time after anal fistula surgery?

Last year, I posted twice inquiring about issues after anal fistula surgery.
On 11/23, I asked about the recovery status after anal fistula surgery (https://adoctor.tw/article/176000) and on 11/27, I inquired about wound care after the fistula surgery (https://adoctor.tw/article/176154).
The surgery was performed on November 11 of last year, and it has been 67 days since the operation.
Currently, the wound is as shown in this image: https://ibb.co/ryQkzvv.

In the past two weeks, the wound healing has been very slow.
During my follow-up on January 10, the attending physician stated that there was no recurrence because I underwent an "excisional surgery," which results in a larger wound.
The physician mentioned that they have encountered patients whose healing took 2 to 3 months.
However, the wound healing has been very slow in the past two weeks, and I feel that it may not heal in three months, especially the wound near the anal area, where the granulation tissue healing is not ideal.
I do not smoke or drink, and post-surgery, I have been eating more chicken and eggs.
I take B vitamins in the morning, vitamin C at noon, and zinc in the evening.
The dressing change method remains the same, with changes in the morning and evening, applying a thin layer of Neosporin on the gauze.

At my age (20s), the wound should not be healing this slowly.
Additionally, I feel uncomfortable after sitting for about half an hour.
I have a few questions I would like to ask:
1.
From the Q&A history, I see many responses stating that healing occurs within 1 to 2 months.
Does this 1 to 2 months healing time refer to "incisional surgery" with smaller wounds?
2.
For this type of excisional surgery, could the healing time extend to 3 to 4 months?
3.
Following up on the previous question, have there been any patients that Dr.
Zhang has treated who experienced a healing time of 3 to 4 months without recurrence?
4.
For any "excisional surgery" with a large wound, is it necessary for the healing time to be more than 2 months?
5.
Since "excisional surgery" involves removing the entire fistula, should the recurrence rate be lower than that of "incisional surgery"? Is it even possible to say that recurrence is unlikely?
6.
I found information online about methods to accelerate wound healing, including "hyperbaric oxygen therapy." Can hyperbaric oxygen be used to speed up the healing of anal fistula wounds?

Tom, 20~29 year old female. Ask Date: 2022/01/16

Dr. Zhang Shuhao reply Surgery

The wound is much smaller than before and appears to be healthy.
Sometimes, when the granulation tissue grows excessively and covers the surrounding skin, it may need to be slightly trimmed (usually done in the outpatient clinic using silver nitrate sticks or cryotherapy with liquid nitrogen).
However, even if left untreated, it typically continues to grow gradually.
Healing of extensive fistula surgery wounds may take several months, with cases extending beyond 3-4 months being quite common, depending on the extent of the surgery and individual healing factors.
Excisional surgery has a lower recurrence rate compared to incisional surgery, and excisional surgery is generally preferred when it does not affect function.
The excised area will not recur due to the removal of glands (though glands may still exist in other areas around the anus).
Hyperbaric oxygen therapy can be somewhat beneficial for wound healing, but in your case, simply changing the dressings for a while and attending regular follow-up appointments to monitor the wound is sufficient; hyperbaric oxygen is not necessary.
Maintaining your current healthy lifestyle, you do not need to constantly focus on the wound; staying optimistic will help, and one day you may find that the wound has healed without you even realizing it.
Wishing you a speedy recovery.

Reply Date: 2022/01/16

More Info

Understanding the healing time after anal fistula surgery is crucial for patients and their caregivers. Anal fistula surgery, particularly the excision type, can have varying recovery times based on several factors, including the extent of the surgery, the patient's overall health, and adherence to post-operative care instructions.

1. Healing Time Expectations: The typical healing time for anal fistula surgery can range from 1 to 2 months for smaller, less invasive procedures. However, for more extensive surgeries, such as complete excision of the fistula, healing can take longer—often extending to 3 to 4 months. The healing process is influenced by the size of the wound and the individual’s healing capacity. In your case, since the surgery was performed on November 11 and you are now 67 days post-operation, it is not uncommon for healing to be slower, especially if the wound is larger or located near sensitive areas like the anal canal.

2. Factors Affecting Healing: Several factors can contribute to delayed healing. These include the size of the surgical site, the presence of any underlying health conditions (such as diabetes), nutritional status, and even lifestyle choices like smoking and alcohol consumption. You mentioned that you do not smoke or drink, which is beneficial for healing. However, ensuring adequate protein intake (from sources like chicken and eggs) and vitamins (like B and C) is essential for tissue repair.

3. Patient Experiences: It is not unusual for patients to experience healing times of 3 to 4 months, especially after a more extensive excision. Your surgeon's experience with other patients who have taken this long to heal suggests that your situation is not unique. Each patient's body responds differently to surgery, and some may take longer to heal without any signs of infection or recurrence.

4. Surgical Technique and Recurrence: The type of surgery performed does impact the likelihood of recurrence. A complete excision of the fistula generally has a lower recurrence rate compared to a simple incision and drainage. This is because the entire fistulous tract is removed, reducing the chances of any remaining tissue that could lead to a recurrence. However, it is essential to follow up with your surgeon to monitor the healing process and address any concerns.

5. Post-Operative Care: Proper wound care is vital for healing. It seems you are following a diligent routine of changing dressings and applying ointments. If you notice any signs of infection (increased redness, swelling, or discharge), it is crucial to contact your healthcare provider immediately. Additionally, if discomfort persists beyond what is expected, discussing pain management options with your doctor may be beneficial.

6. Hyperbaric Oxygen Therapy: Regarding the use of hyperbaric oxygen therapy (HBOT) to enhance wound healing, there is some evidence suggesting that it can improve healing in certain types of wounds by increasing oxygen supply to the tissues. However, its application for anal fistula surgery recovery is less common and should be discussed with your healthcare provider. They can provide guidance on whether this therapy is appropriate for your specific situation.

In summary, while the healing process after anal fistula surgery can be lengthy, especially for larger excisions, it is essential to maintain communication with your healthcare provider. They can offer personalized advice based on your healing progress and any concerns you may have. If you feel that your healing is significantly delayed or if you experience new symptoms, do not hesitate to seek further evaluation.

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