Fistula Surgery: Recurrence and Treatment Options Explained

Q: Fistula Surgery: Recurrence and Treatment Options Explained

Hello： In response to your question, fistula surgery can sometimes result in recurrence. <br>Generally, this is due to the previous surgery not identifying the internal opening of the fistula in the anal canal. <br>If a repeat surgery is not performed, the likelihood of spontaneo

Fistula surgery

Hello Dr.
Ke,
I underwent two fistula surgeries at Chang Gung Hospital over two years ago, with a three-month interval between them.
The attending physician mentioned that my fistula was quite deep, necessitating two separate surgeries for complete removal.
I followed up with regular check-ups until I was informed that further follow-ups were no longer needed.
However, recently I have been experiencing some unusual sensations around my anus, and after undergoing another examination (sometimes it hurts, sometimes it doesn’t), I was informed that there might be a recurrence.

I would like to ask Dr.
Ke if the recurrence is due to incomplete removal or treatment from before.
Since there is no pain, is it acceptable to just monitor the situation without undergoing another surgery? I am concerned about the high risk of fecal incontinence associated with another surgery.
Would it be possible to consider alternative treatments such as incision or the Seton Tie Technique? Thank you.

Stephen, 40~49 year old female. Ask Date: 2006/12/29

Dr. Ke Fangxu reply Surgery

Hello: In response to your question, fistula surgery can sometimes result in recurrence.
Generally, this is due to the previous surgery not identifying the internal opening of the fistula in the anal canal.
If a repeat surgery is not performed, the likelihood of spontaneous healing is relatively low.
For complex or high anal fistulas, the Seton Tie Technique is typically used, while simple or superficial types may be treated with incision.
Given your condition, the Seton Tie Technique may be more appropriate; however, it has the downside of postoperative pain, requires weekly follow-ups, and has a longer healing time, but it is less likely to result in anal incontinence as a complication.

Reply Date: 2006/12/29

More Info

Fistula surgery, particularly in the context of anal fistulas, can be a complex and challenging area of treatment. The recurrence of symptoms after surgical intervention is not uncommon and can be influenced by several factors, including the depth and complexity of the fistula, the surgical technique employed, and the individual’s healing process.

In your case, having undergone two surgeries for the removal of a deep fistula, it is understandable to be concerned about the possibility of recurrence. Recurrence can occur for various reasons, such as incomplete removal of the fistula tract during surgery, the presence of multiple tracts, or the development of new fistulas. It is also possible that the fistula may have been adequately treated initially, but new issues have arisen since then.

When it comes to managing a suspected recurrence, the approach can vary depending on the severity of the symptoms and the findings during examination. If you are experiencing discomfort or pain, it is essential to address these symptoms, as they can indicate an active issue that may require intervention. However, if the symptoms are mild and intermittent, some healthcare providers may recommend a watchful waiting approach, allowing for monitoring without immediate surgical intervention.

The concern about the risk of fecal incontinence following additional surgery is valid. Surgical procedures for anal fistulas can carry risks, especially if the fistula is located near the anal sphincter. Techniques such as the Seton technique can be beneficial in managing fistulas while minimizing the risk of incontinence. This method involves placing a suture through the fistula tract to help drain any infection and promote healing over time, without the need for immediate complete excision.

If you are considering non-surgical options, it is crucial to maintain regular follow-ups with your healthcare provider. They can monitor your condition and assess whether any changes occur that would necessitate further intervention. Additionally, lifestyle modifications, such as dietary changes to ensure soft stools and proper hygiene, can help manage symptoms and prevent complications.

In summary, the recurrence of anal fistulas after surgery can be a complex issue influenced by various factors. While it is possible to monitor mild symptoms, it is essential to remain vigilant and consult with your healthcare provider regarding any changes. Surgical options, including the Seton technique, may provide a safer alternative to complete excision, especially in cases where there is a risk of fecal incontinence. Open communication with your healthcare team will be vital in determining the best course of action for your situation.

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