Anal Fistula Surgery: Addressing Post-Operative Concerns

Anal fistula issues?

Hello Dr.
Ke, my father has developed something resembling acne near his anus, which has repeatedly become infected and ruptured.
The doctor diagnosed it as a fistula and he underwent fistula surgery a week ago.
However, during the follow-up appointment one week post-surgery, another rupture was discovered.
When I inquired with the surgeon, I was informed that due to health insurance regulations, only one fistula can be excised at a time, and any remaining ones found during surgery cannot be removed.
I would like to know if this is reasonable.
What is the purpose of the surgery if it does not resolve the issue and results in another incision? I kindly ask for your clarification, thank you!

Ms. Li, 30~39 year old female. Ask Date: 2023/01/19

Dr. Ke Fangxu reply Surgery

The National Health Insurance does not stipulate that an anal fistula surgery can only remove one site at a time.
It is likely that another site was not detected during the initial surgery and therefore was not removed.
A second surgery may be unavoidable.
However, it may be better to consider conservative treatment before the wound from the first surgery has healed.
If the two fistulas are connected, it would be classified as a complex fistula, making treatment more complicated.
If they are not interconnected, the surgery would be simpler.

Reply Date: 2023/01/19

More Info

Understanding anal fistula surgery and addressing post-operative concerns can be quite complex, especially when dealing with recurrent issues like those your father is experiencing. Anal fistulas, which are abnormal connections between the anal canal and the skin near the anus, can often lead to discomfort, pain, and recurrent infections. Surgical intervention is typically the most effective treatment, but the outcomes can vary based on several factors, including the complexity of the fistula and the surgical technique used.

In your father's case, it seems he underwent a surgical procedure to address the anal fistula, but post-operative complications arose, leading to the discovery of another lesion that required further attention. The fact that the surgeon indicated that only one fistula could be addressed at a time due to health insurance regulations raises important questions about the rationale behind such a decision.

From a medical standpoint, it is not uncommon for surgeons to prioritize certain lesions based on their assessment of the most pressing issues. However, if multiple fistulas are present, it is generally more effective to address them in a single surgical session to minimize the risk of recurrence and reduce the overall burden of surgery on the patient. The rationale for treating only one fistula at a time may stem from a desire to minimize surgical trauma, manage post-operative recovery more effectively, or adhere to specific health insurance policies that limit the scope of procedures performed in a single operation.

The concern you raise about the effectiveness of the surgery is valid. If the surgery does not resolve the underlying issue and leads to the need for additional procedures, it can understandably lead to frustration and confusion. The primary goal of fistula surgery is to achieve complete healing and prevent recurrence. If this is not achieved, it may necessitate further evaluation of the surgical technique used, the type of fistula, and any underlying conditions that may contribute to the persistence of the problem.

In terms of post-operative care, it is crucial for your father to follow up closely with his healthcare provider. This includes monitoring for signs of infection, managing pain, and ensuring proper wound care. If new lesions continue to appear, it may be beneficial to seek a second opinion or consult with a specialist in colorectal surgery who has experience with complex anal fistulas. They may be able to provide additional insights into the best course of action, whether that involves further surgical intervention or alternative treatment options.

In conclusion, while the decision to treat only one fistula at a time may be influenced by various factors, including insurance regulations, it is essential to ensure that the overall treatment plan effectively addresses all issues present. Open communication with the surgical team and possibly seeking additional opinions can help clarify the best path forward for your father's health and well-being.

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