Post-Surgery Concerns: Managing Persistent Drainage Tube After Fistula Repair

Postoperative care after anal fistula surgery?

Hello, doctor.
I had an anal fistula surgery on November 8th last year, and there is still a white plastic tube protruding from the site that hasn't fallen out.
Each time I return for a follow-up, the doctor pulls on it and ties it with a rubber band, but it still hasn't come out.
The doctor mentioned that if it doesn't fall out soon, I may need another surgery to remove a piece of tissue to take out the tube.
However, I have read that others who underwent fistula surgery did not have this white tube placed, and none of them had issues with it not coming out.
Additionally, I have developed a lot of granulation tissue, and the wound has not healed; I experience daily discharge and even some bleeding.
What could be the reason for this? Is this normal? Are there any solutions? Thank you.

Coco, 40~49 year old female. Ask Date: 2022/02/08

Dr. Zhang Shuhao reply Surgery

This plastic tube is a special type of fistula treatment known as a "seton." It is used when the fistula passes through the high anal sphincter to avoid cutting too much sphincter muscle at once, which could lead to incontinence.
As the plastic tube is gradually tightened in the outpatient setting, the wound will gradually shrink, which typically takes several weeks to even months.
If the wound shrinks to a certain extent and surgery can be performed without affecting sphincter function, it may be possible to schedule an earlier surgery for removal.
This should be discussed with your attending physician.
Before your follow-up appointment, you can continue warm sitz baths and change the dressing with ointment, so there is no need to worry excessively.
Wishing you a speedy recovery.

Reply Date: 2022/02/08

More Info

Post-surgery concerns, especially after a fistula repair, can be quite complex and often require careful management. Based on your description, it seems you are experiencing some common issues that can arise after such procedures, particularly with the presence of a drainage tube and ongoing drainage from the surgical site.

Firstly, the presence of a plastic drainage tube (often referred to as a "drain") after fistula surgery is not uncommon. These drains are typically placed to help remove excess fluid and prevent the accumulation of pus or blood in the surgical area, which can lead to infection or delayed healing. However, if the drain remains in place for an extended period, as you described, it can become a source of frustration and concern.

The fact that your doctor has mentioned the possibility of needing to surgically remove the drain if it does not come out on its own suggests that it may not be functioning as intended. Drains are usually designed to be temporary, and if they are not falling out or being removed naturally after a reasonable period, it could indicate that there is an issue with the healing process or the drain itself.

Regarding the development of granulation tissue (often referred to as "meat" or "flesh" growth), this is a normal part of the healing process. Granulation tissue forms as the body attempts to heal the wound, but excessive granulation can occur, especially if there is ongoing irritation or if the area is not healing properly. The presence of drainage and occasional bleeding can also be indicative of inflammation or infection, which may require further evaluation.

Here are some considerations and recommendations based on your situation:
1. Consult Your Surgeon: It is crucial to maintain open communication with your surgeon regarding your concerns. If the drain has not fallen out and you are experiencing significant drainage, it may be necessary to reevaluate the situation. Your surgeon can assess whether the drain is still needed or if it should be removed surgically.

2. Monitor for Infection: Keep an eye on the drainage for any signs of infection, such as increased redness, warmth, swelling, or a change in the color or odor of the discharge. If you notice any of these symptoms, contact your healthcare provider immediately.

3. Manage Granulation Tissue: If the granulation tissue is excessive, your doctor may recommend treatments to reduce it, such as topical medications or procedures to remove the excess tissue. This can help promote better healing and reduce irritation.

4. Wound Care: Continue to follow your doctor's instructions for wound care. Keeping the area clean and dry is essential. If you are advised to use specific ointments or dressings, adhere to those recommendations.

5. Consider a Second Opinion: If you feel uncertain about the management of your condition or if your concerns are not being adequately addressed, seeking a second opinion from another colorectal surgeon may provide additional insights and options.

6. Patience with Healing: Healing from fistula surgery can take time, and it is not uncommon for patients to experience prolonged drainage and discomfort. However, if your symptoms persist or worsen, further intervention may be necessary.

In summary, while some drainage and granulation tissue can be normal after fistula repair, the persistence of a drain and ongoing symptoms warrant further evaluation. Your healthcare provider is your best resource for navigating these concerns and determining the appropriate next steps for your recovery.

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