Fistulotomy: Purpose, Procedure, Benefits and Side Effects

A surgical technique called fistulotomy is done to treat fistula. Fistula is the medical term for an improper connection between two bodily parts, such as between the bladder and skin or the rectum and vagina.

• Simple Fistulotomy: A simple fistulotomy is a procedure that involves making an incision along the length of an abnormal tract or fistula in the anus. The fistula is then opened up, allowing healthy tissue to heal and close the opening.
• Advancement Flap Fistulotomy: This procedure uses a flap of skin and tissue from nearby healthy anal tissue to cover the opening of the fistula.
• Lifting Flap Fistulotomy: This procedure requires two stages and involves removing a portion of the fistula tract, lifting up surrounding healthy anal tissue, and suturing it in place over the opening of the fistula.
• Laser Fistulotomy: Laser fistulotomy is a newer, minimally invasive procedure that uses lasers or radiofrequency energy to open up and remove any remaining parts of the abnormal tract or fistula.

• Relief of discomfort: Fistulotomy provides relief from the discomfort caused by an anal fistula, such as pain and itching.
• Reduced risk of infection: Fistulotomy reduces the risk of infection and the spread of bacteria, which can cause further complications.
• Improved healing: Fistulotomy promotes healing due to its ability to cut away damaged tissue and create a clear pathway for drainage.
• Minimally invasive: Fistulotomy is a minimally invasive procedure that does not require general anaesthesia or long hospital stays, making it a preferred treatment option for many patients.
• Low recurrence rate: The recurrence rate for fistulotomies is low, meaning that the procedure is effective in treating anal fistulas in most cases.

• The goal of the procedure is to open up the fistula, which is a passageway that connects two hollow spaces, such as two different sections of the intestine or between the intestine and the skin.
• Fistulotomy is done to remove any infected or inflamed tissue in the fistula and to prevent further infection or inflammation.
• By enhancing drainage and enabling a faster and more thorough healing process, it may also aid in reducing pain and suffering brought on by the fistula.

• Bleeding: Fistulotomy can cause significant bleeding due to the cutting of tissue and vessels.
• Infection: Since the procedure involves cutting through the skin, infection is a common risk.
• Damage to nearby structures: During a fistulotomy, there is a risk of accidentally damaging nearby structures such as nerves or muscles.
• Stenosis: The opening created during a fistulotomy can become too narrow, resulting in stenosis.
• Recurrence: Fistulotomy does not always provide a permanent solution and the fistula may recur after the surgery.

• Before a fistulotomy, your doctor will perform a physical exam and order tests such as an MRI or CT scan to determine the exact location and size of the fistula.
• Your doctor will also go through any potential hazards and side effects of the treatment.
• You may be asked to stop taking any medications that increase your risk of bleeding, such as aspirin or other anti-inflammatory drugs.
• You should also make arrangements for transportation home following the treatment.
• On the day of your surgery, you should wear loose-fitting clothing and avoid eating or drinking for 8 hours prior to your appointment.

Here are the steps of a fistulotomy:

• The surgeon will make an incision in the skin over the area of the fistula, down to the level of the sphincter muscles.
• The surgeon will then cut through the sphincter muscles and open up the fistula, allowing it to drain.
• The edges of the fistula will be trimmed and stitched together, allowing them to heal properly with minimal scarring.
• Patients may have some discomfort and soreness after the surgery, which may be treated with medicine provided by their doctor.
• Patients may also need to stay in hospital for a few days after surgery for monitoring and recovery, before being discharged home with instructions on how to care for their wound site at home.

• A complete physical examination should be carried out to evaluate the patient's general health before fistulotomy. Checking vital indicators including blood pressure, heart rate, and respiration rate is part of this. The medical history of the patient should also be examined to rule out any possible issues or contraindications to the surgery.
• Before the operation, the patient's family should sign an informed consent document. This document outlines the risks and benefits associated with fistulotomy and allows the patient to make an informed decision about whether or not to proceed with it.
• The area around the fistula should be thoroughly cleaned with antiseptic solution prior to surgery in order to reduce infection risk.
• The patient should be instructed to empty their bowels completely before surgery in order to reduce risk of contamination during the procedure.
• The patient should be prepped for anaesthesia prior to fistulotomy in order to ensure that they will remain comfortable throughout the procedure and reduce risk of complications due to movement during surgery.

Before the procedure, the patient receives local or general anaesthesia so they won't experience any discomfort.
• In order to reach the fistula, the surgeon will create an incision in the skin there.
• The fistula is then opened up carefully and any abnormal tissue inside it is removed.
• The edges of the opening are then stitched together with absorbable sutures to close it off and prevent further infection.
• After closing off the fistula, the surgeon will check for any signs of infection in the area and may place a drain near the incision site to allow any fluids to escape from it while healing takes place over time.
• Finally, once all steps are completed, a bandage or dressing is placed over the wound to protect it from further damage and keep it clean until healing has completed.

• The patient should avoid sitting or standing in one position for long periods of time, as this could cause irritation to the wound area.
• It is important to keep any stitches used in the procedure clean and dry and to follow any instructions provided by the surgeon about removing them at an appropriate time.
• The patient should also take necessary measures to prevent infection such as keeping the wound area clean, avoiding swimming pools and public baths, and regularly washing their hands with warm water and soap before touching the wound area.
• The patient should also avoid strenuous activities such as lifting heavy objects or exercising until they have been cleared by their doctor.
• Finally, regular follow-up appointments with a medical professional should be scheduled to ensure that the healing process is progressing correctly and that any complications can be addressed as soon as possible.

The average cost for Fistulotomy in India is around Rs. 10,000 - 20,000. The precise price, however, may change based on the hospital, doctor, and other considerations.

After a fistulotomy, the patient should take it easy and rest for at least 24 hours.
They should wait until their doctor provides the all-clear before engaging in intense activities or heavy lifting.
To lower the chance of infection, the patient should also keep the area dry and clean.
Depending on their doctor's advice, they may also need to take antibiotics for a few days.
Additionally, they may need to use a soft and absorbent dressing over the wound until it heals.

The diet after a fistulotomy is similar to any other post-operative recovery diet.

You should concentrate on consuming a balanced diet that is high in fruits, vegetables, lean protein, complex carbs, and healthy fats. Processed foods, alcohol, coffee, and sugar should all be avoided.

In order to promote healing and lower the chance of constipation, your doctor may also advise consuming meals rich in fibre and drinking plenty of water.

Yes, fistulotomy is generally considered to be safe.

The risks are normally low and the operation is often performed as an outpatient surgery.

However, as with any medical procedure, there may be some risks and potential complications associated with the surgery, so it is important to discuss these with your doctor before proceeding.

Yes, Fistulotomy can be a painful procedure, although the amount of pain experienced can vary from person to person.

In most cases, pain medications and other forms of pain management can be used to help make the procedure more comfortable.

The recovery period after a fistulotomy varies from person to person, but typically takes from two weeks to six weeks.

During this time, it is important to take measures to keep the area clean and dry to avoid infection.

Over the duration of the healing process, your doctor will provide you detailed instructions on how to take care of your wound.

The most common side effects of fistulotomy are pain and soreness in the areas around the fistula, as well as temporary swelling, redness and drainage from the wound.

Moreover, some patients report feeling tenderness and a burning sensation in the region.

Other possible side effects include bleeding, infection, scarring or recurrence of the fistula.

Also, there is a chance that neighbouring organs or tissues, including the bladder or rectum, might be harmed during surgery.

In rare cases, fistulotomy can cause complications such as injury to adjacent nerves or blood vessels, incontinence or bowel obstruction.

Rest: It's crucial to take it easy after a fistulotomy and let your body recuperate. After surgery, refrain from heavy activity for at least 4-6 weeks.

Keep the wound clean: Make sure to keep the fistula site clean and dry. Change bandages as needed and gently wash the area with soap and warm water a few times a day.

Take medications as prescribed: It is important to take any pain relievers or antibiotics prescribed by your doctor as directed.

Avoid physical activities: Avoid activities such as running, jumping or swimming that may put strain on the wound site and slow down the healing process.

Follow-up visits with your doctor: It is important to follow up with your doctor after fistulotomy surgery to monitor healing progress and ensure there are no complications, such as infection or bleeding.

Anal fistulas, which are aberrant connections between the rectum and the skin around the anus, are treated surgically using fistulotomies.

The procedure involves making an incision in the fistula and removing any abnormal tissue, allowing normal tissue to heal and close off the fistula.

Fistulotomy is a minimally invasive procedure that can provide relief from discomfort associated with an anal fistula and reduce the risk of infection or recurrence.

However, there are some risks associated with this procedure, so it is important to discuss these with your doctor before proceeding.