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Anal Fistula Repair

Fistulotomy

In simple (or low) fistulas, a fistulotomy is performed. This is a straightforward operation. It is usually performed under general anaesthetic and as a day procedure. An examination is performed under anaesthetic to confirm the fistula and detail the anatomy. A probe is passed through it revealing both the external (perianal skin) opening and the internal (anal canal) opening. The fistula is laid open leaving an open wound in the perianal region that heals from the bottom up. The success of this procedure is over 95%.

What to expect post-operatively

The perianal wound will take some time to heal. Depending on the size, it can take between 2 and 6 weeks to completely heal.

Pain

Local anaesthetic will be injected into the wound at the end of the operation and therefore you should be comfortable when you wake up. There will be discomfort in the perianal region for the first few days to some weeks afterwards. You should take regular analgesia in the first 48 hours including paracetamol (Panadol) 1g (2 tabs) every 4-6 hours (max 8 tabs per day) and an anti-inflammatory such as ibuprofen (nurofen) 400mg every 4 – 6 hours. You may be given a prescription for a stronger pain killer such as oxycodone (endone) or tramal (tramadol) to use in addition as well. After 48 hours, use the painkillers only if needed.

Wound

Most commonly, no dressings are needed in the wound and a simple sanitary pad should be worn in the under wear to collect any discharge. Occasionally, daily internal dressings are needed and a district nurse will be organised to do this at home. Discharge from the wound is expected and can last for weeks. This is normal. The discharge can be blood stained and/or pus like. Keep the wound clean by showering with soap and water or by taking a salt bath (add table salt to a warm bath), pat the wound dry and replace the sanitary pad.

Bowel motions

It is important to keep the bowel moving. Use either movicol 1-2 sachets daily or Metamucil 1-2 sachets daily if needed for a few weeks (especially if using endone). Try not to strain.

Work and Exercise

You can return to work and exercise when you feel comfortable. This may be a couple of days for some people and some weeks for others.

Complications

Complications are unusual.

Excessive bleeding – more than half a cupful that cannot be controlled by simple pressure on the wound

Infection – this is rare. A high fever, chills or spreading redness at the site may indicate infection

Recurrence of the fistula or perianal abscess

Faecal Incontinence – this is rare and if happens, is usually mild

  • Prince of Wales Private Hospital
  • The Royal Hospital For Women Foundation
  • Colorectal Surgical Society of Australia and New Zealand
Randwick Rooms

Prince of Wales Private
Suite 17, Level 7
Barker Street
Randwick NSW 2031

Phone: 1300 553 347
Fax: (02) 9650 4924

Double Bay

Double Bay Day Hospital Specialist Suites
Suite 3.01, Level 3, commercial
451 New South Head Road
Double Bay

Phone: 0290 863 133
Fax: (02) 9086 3123

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