Persistent Anal Fistula: Do I Need Another Surgery for Ongoing Symptoms?

An anal fistula is characterized by the continuous formation of abscesses either internally or externally?

Hello Dr.
Chen, I would like to ask about a situation.
I had surgery for an anal abscess on May 28, 2022, where it was incised and drained.
After the surgery, the wound has not fully healed, and there is a 1 cm deep and 0.6 cm wide hole.
After bowel movements, sometimes stool gets stuck in that hole, and at times there is yellow discharge.
Occasionally, yellow pus forms.
Do I need to undergo another surgery?

Mu Zi, 40~49 year old female. Ask Date: 2023/02/02

Dr. Zhang Shuhao reply Surgery

If an anal abscess continues to swell and cause pain after drainage, and there is purulent discharge, it may indicate the formation of an anal fistula.
It is recommended to visit a colorectal clinic for examination.
If a fistula is confirmed, surgical excision is necessary to prevent recurrence.

Reply Date: 2023/02/02

More Info

Persistent anal fistulas can be a challenging condition to manage, especially after an initial surgery for an anal abscess. Based on your description, it seems that you have developed a persistent defect or opening in the anal area that has not healed properly since your surgery in May 2022. The presence of a 1 cm deep and 0.6 cm wide opening that occasionally traps stool and produces yellow discharge or pus is concerning and suggests that the fistula may not have fully resolved.

In cases like yours, it is important to consider a few factors before deciding on the need for another surgical intervention:
1. Assessment of Symptoms: The ongoing symptoms you describe, including the discharge and the presence of pus, indicate that there may still be an active infection or inflammation in the area. This could be a sign that the fistula has not healed properly, and it may require further surgical intervention to address the underlying issue.

2. Surgical Evaluation: A thorough evaluation by a colorectal surgeon is essential. They will likely perform a physical examination and may recommend imaging studies, such as an MRI or endoanal ultrasound, to assess the extent of the fistula and any associated complications. This evaluation will help determine the best course of action.

3. Surgical Options: If it is determined that the fistula is persistent and symptomatic, surgical options may include:
- Fistulotomy: This involves cutting open the fistula tract to allow it to heal from the inside out.

- Seton placement: In some cases, a seton (a piece of material) may be placed in the fistula to help drain it and promote healing over time.

- Flap procedures: For complex fistulas, a flap procedure may be necessary to close the defect and promote healing.

4. Risks of Surgery: As with any surgical procedure, there are risks involved, including infection, bleeding, and potential changes in bowel function. It is important to discuss these risks with your surgeon to make an informed decision.

5. Postoperative Care: If you do undergo another surgery, proper postoperative care will be crucial for healing. This may include maintaining good hygiene, avoiding constipation, and following up with your healthcare provider to monitor healing.

In conclusion, based on your ongoing symptoms and the description of your condition, it is advisable to consult with a colorectal surgeon for a comprehensive evaluation. They will be able to provide tailored recommendations based on your specific situation and help determine if another surgery is necessary to address the persistent anal fistula. Early intervention can often lead to better outcomes and improved quality of life.

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