Perianal fistula: surgical treatment

After learning what a Perianal Fistula is and what symptoms it presents, the next step is to know how is the surgical treatment of this pathology.

The aim of perianal fistula surgery is the total healing of the fistula and the preservation of an adequate sphincter function that avoids the appearance of undesirable sequelae such as incontinence.

Treatment of a fistula

The treatment of perianal fistula is exclusively surgical and should always be entrusted to a specialist, since the decisions made by the surgeon can have an enormous impact on the patient’s future quality of life. The surgeon must have several therapeutic options at his disposal in order to approach each case in an individualized manner and duly agreed with the patient. This may require the support of some complementary radiological explorations that help to make the surgical decision.

During the last few years, perianal fistula surgery has been preferentially oriented towards increasingly less aggressive surgical procedures that avoid extensive wounds, many of them burdened with long healing periods. These techniques, in turn, are providing increasingly satisfactory results.

Very often, fistula treatment requires several interventions. In the first, a rubber or silk support known internationally as a seton (fishing line) is placed along the fistulous tract. This line is introduced along the entire length of the fistula and emerges through the internal and external orifices of the fistula, joining both ends outside in the form of a loop. This is intended to consolidate the fistula trajectory, avoid new infections and make it more approachable for the second surgery. This is performed after two or three months, during which time the patient can lead a normal life without any type of restrictions.

See also  Anal fistula, always treated in the operating room

The technique of the definitive surgery depends on the surgeon’s preferences and experience with each one of them. The use of biological substances to seal the fistula tract, or the localization and section of the fistula by means of a minimal surgical incision are some of the preferred techniques, which provide a cure rate of more than 75%.

After surgery

A perianal fistula operation does not prevent new fistulas from arising in the future. There is undoubtedly a recurrence rate. However, modern, less aggressive techniques make it possible to face this situation with greater optimism than in the past. The main advantage of this operation is that after surgery the patient is fully recovered and, after a reasonable period of rest and with some simple cures, can return to daily life as normal.