Post-Surgery Concerns: Managing Anal Fistula and Granulation Tissue

Q: Post-Surgery Concerns: Managing Anal Fistula and Granulation Tissue

Hello, Xiao Zhi： Surgery for anal fistulas may sometimes result in faster healing of wounds outside the anal glands, especially in younger individuals with better wound healing capabilities. <br>This can lead to the internal wound of the fistula being surrounded again, resulting

Postoperative Issues Related to Anal Fistula Surgery 2

Hello Dr.
Ke,
I would like to ask you some questions.
After my anal fistula surgery on April 2, my wound has not fully healed.
Occasionally, I notice some blood when wiping after a bowel movement.
On June 16, I went to another hospital for a check-up, and the doctor said that my wound has not formed granulation tissue and has developed a polyp.
The doctor prescribed a suppository for me to use rectally.
I would like to ask you:
1.
Will the polyp disappear with the suppository?
2.
If it does not disappear, will I need to undergo another surgery to remove it? (Will this removal require another spinal anesthesia?)
3.
If I do not have the polyp removed, could there be any complications?
4.
Why did the polyp develop, and why has my wound not healed completely after such a long time?
5.
What foods should I eat to promote healing? Are there any foods I should avoid?
Thank you for your assistance.
[Response Date] 2010/06/21
[Response] Dr.
Ke, Keelung Hospital / Surgery / Dr.
Fang-Hsu Ke
Hello, generally speaking, the wound from anal fistula surgery should heal within about a month.
If it has not healed after more than two months, there may be an issue.
The so-called polyp is likely residual granulation tissue, and it should be checked to see if it is due to incomplete removal of the fistula.
1.
The polyp will likely not disappear with the suppository.
2.
If there is residual fistula tissue, another surgical intervention may be necessary.
3.
If surgery is not performed, it would render the previous surgery ineffective, as the fistula would still be present.
4.
As mentioned above.
5.
In young individuals, wound healing should not be significantly affected by diet unless there is insufficient protein intake or immune deficiency.
I recommend you return to the original surgeon for a follow-up and inquire whether another surgical treatment is needed.
The doctor mentioned that there is granulation tissue on the outside of my anus, but not on the inside.
If surgery is required, the wound will need to be opened up a bit more.
He prescribed indomethacin suppositories to be used once daily in the morning (is this really ineffective?).
Also, aside from surgery, is there no way to eliminate the polyp using cautery or laser?

Xiao Zhi, 20~29 year old female. Ask Date: 2010/06/21

Dr. Ke Fangxu reply Surgery

Hello, Xiao Zhi: Surgery for anal fistulas may sometimes result in faster healing of wounds outside the anal glands, especially in younger individuals with better wound healing capabilities.
This can lead to the internal wound of the fistula being surrounded again, resulting in the formation of a new fistula.
The issue at this point lies not with the external polyp but with the internal wound, which remains unhealed even after the polyp is removed.
I understand the fear of undergoing another surgery; however, if you want to address both the external and internal issues, undergoing surgery again is the best option.
If you prefer not to have another surgical treatment, you might consider trying antibiotic therapy along with warm sitz baths to see if the wound has a chance to heal.

Reply Date: 2010/06/21

More Info

After undergoing anal fistula surgery, it is not uncommon to experience complications such as delayed wound healing and the formation of granulation tissue, commonly referred to as "flesh" or "proud flesh." Your concerns about the healing process and the presence of this tissue are valid and warrant a thorough understanding of the situation.

1. Granulation Tissue and Suppositories: Granulation tissue is a normal part of the healing process, but excessive granulation can be problematic. The suppositories prescribed by your physician may help reduce inflammation and promote healing, but they are unlikely to eliminate the granulation tissue entirely. Granulation tissue is typically more resilient and may require more direct intervention if it does not resolve on its own.

2. Surgical Intervention: If the granulation tissue does not diminish with conservative treatment, surgical removal may be necessary. This would likely involve a minor surgical procedure, which may require anesthesia. The decision to proceed with surgery should be made in consultation with your surgeon, who can assess the extent of the tissue and the underlying issues related to your original fistula.

3. Potential Complications: If the granulation tissue is a result of residual fistula tissue that was not completely excised during the initial surgery, failing to address it could lead to recurrent symptoms or complications. This could include persistent pain, bleeding, or the formation of new fistulas. Therefore, it is crucial to follow up with your original surgeon to evaluate the situation and determine the best course of action.

4. Delayed Healing: The reasons for delayed healing can vary. Factors such as infection, inadequate blood supply to the area, or the presence of foreign material can impede the healing process. Additionally, if the original fistula was not completely removed, it can lead to ongoing irritation and prevent proper healing. It is essential to have a thorough evaluation to identify any underlying issues.

5. Dietary Considerations: While diet plays a role in overall health and healing, it is generally not a primary factor in the healing of surgical wounds unless there is a significant deficiency. Ensuring adequate protein intake is essential for tissue repair, so incorporating protein-rich foods like lean meats, dairy, legumes, and nuts can be beneficial. Staying hydrated and consuming a balanced diet rich in vitamins and minerals can also support the healing process.

In summary, it is crucial to maintain open communication with your healthcare provider regarding your recovery. If you are experiencing persistent issues, such as bleeding during bowel movements or the presence of granulation tissue, a follow-up appointment is necessary. Your surgeon can provide a comprehensive evaluation and determine whether further intervention is needed. Remember, healing can take time, and addressing any complications early can lead to better outcomes.

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