Fistula Issues: When to Observe or Consider Surgery?

Fistula issues, inquiry supplement 192905?

Hello, doctor (the previous inquiry number is 192905).
Today, a general surgical ultrasound was performed on the elongated mass extending from the area beside the anus to the thigh and perineal angle down to below the scrotum.
The hard mass was found to contain fluid and measures approximately 1 cm in diameter and 4 cm in length.
It has been present for at least three years, has never become infected, and has only swollen 2-3 times, after which it subsided without any discomfort.
The ultrasound indicates that it is an independent tubular structure filled with fluid, with no adhesions to the skin or underlying muscle.

Could you please advise whether it is possible to simply observe it? If it remains unchanged, can we leave it alone? Or do you recommend surgery? Is it necessary to consult a specialized colorectal surgeon, or can a general surgeon handle it? Is it essential to perform a complete excision as mentioned in some articles, or is it possible to remove the tubular structure using aspiration? Given that it has remained the same size for 2-3 years, could we use a syringe for aspiration and address it if it returns to its original size? Would it be feasible to use a syringe for aspiration followed by injecting concentrated alcohol to destroy the structure? I have many questions, and I would greatly appreciate your time in answering them.
Thank you.

yiwen, 40~49 year old female. Ask Date: 2023/02/23

Dr. Ke Fangxu reply Surgery

If it is not connected to any cavities, it may not be an anal fistula.
If there is no pain, swelling, or inflammation, it can indeed be observed further.
However, if you want to completely resolve this issue, surgical intervention may be necessary.
If it is a fistula, it would require incision and drainage.
If it is a subcutaneous cyst, complete excision is needed; aspiration or injection treatments are less commonly performed and have a higher recurrence rate if not completely removed.

Reply Date: 2023/02/23

More Info

When it comes to managing a fistula, particularly one that has been present for an extended period without significant changes, the decision to observe or consider surgical intervention can be complex. Based on your description, it appears that you have a fistula that has been stable for at least three years, with no signs of infection or significant symptoms other than occasional swelling. This situation raises several important considerations.

First, it is essential to understand what a fistula is. A fistula is an abnormal connection between two body parts, often involving a hollow organ. In your case, it seems to be a tubular structure filled with fluid, which may indicate a chronic condition. The fact that it has not become infected or caused significant discomfort is a positive sign, but it does not necessarily mean that it should be ignored.

Observation vs. Surgery
1. Observation: Given that the fistula has remained stable for three years, observation may be a reasonable approach, especially if it is not causing you any pain or functional issues. Regular follow-ups with your healthcare provider can help monitor any changes in size or symptoms. If the fistula remains asymptomatic, you may not need immediate intervention.

2. Surgery: On the other hand, surgical intervention may be warranted if there is a risk of complications, such as infection, or if the fistula begins to cause discomfort or functional issues in the future. Surgical options can vary from minimally invasive techniques to more extensive procedures, depending on the fistula's characteristics and location.

Choosing the Right Specialist
Regarding whether to consult a general surgeon or a colorectal surgeon, it is generally advisable to seek a specialist in colorectal surgery for fistulas, especially those involving the anal or rectal area. Colorectal surgeons have specific training and experience in managing complex anal and rectal conditions, including fistulas.

Surgical Techniques
If surgery is deemed necessary, the approach will depend on the fistula's anatomy. In some cases, a complete excision of the fistula may be required, while in others, a less invasive technique may suffice. The idea of using a syringe to aspirate the fluid and possibly injecting a sclerosing agent like alcohol is a technique that some practitioners may consider, but it is not universally accepted and can carry risks, including infection or incomplete treatment.

Conclusion
In summary, the decision to observe or proceed with surgery for your fistula should be made in consultation with a qualified healthcare provider, preferably a colorectal surgeon. They can assess the specific characteristics of your fistula and recommend the best course of action based on your individual circumstances. Regular monitoring and follow-up appointments are crucial to ensure that any changes in your condition are addressed promptly. If you notice any new symptoms, such as increased swelling, pain, or discharge, it is essential to seek medical attention promptly.

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