Anal fistula surgery consists of performing different techniques in order to eradicate the fistula with minimal impact on anal function, i.e. anal continence. Dr. Espín is a specialist in the different treatment options for anal fistula, with more than 20 years of experience in coloproctology.
The technique to be used depends on two factors: the local and general conditions of the patient and the complexity of the fistula. There are different techniques, which can range from laying flat (only in patients without risk and with simple fistulas) to the use of glues, grafts, sutures, clips or even stem cells.
Thus, the lay-flat technique is used only in simple fistulas, which means that it does not affect an important part of the internal and external sphincter. This technique has a very low complication rate and a high cure rate of more than 95% success, but it can only be performed in simple fistulas and in patients without risk of incontinence.
In more complex fistulas such as those located in the anterior part of the sphincter in women, or affecting an important part of the external sphincter, other techniques are used. These include: placing glue or making a graft with the mucosa of the canal itself, or other techniques such as the application of a clip, suturing or, in very selected cases, placement of stem cells. The decision as to the best technique should be made by the surgeon with ample experience in the management of this type of patient.
Who can have anal fistula surgery and in which cases is it recommended?
All patients with severe fistula symptoms, such as pus or stool leaking from the fistula, bleeding, pain, etc. should be operated on.
Fistulas that do not produce any symptoms usually do not require surgery, since there is no risk of malignancy and the patient would not benefit from surgical treatment.
Are fistulas always benign?
Fistulas are always benign. We should not confuse the situation with some cases of rectal cancer that may present as abscesses or fistulas; that is, fistulas may be a form of presentation of cancer, but fistulas by themselves are not malignant.
Preoperative care in anal fistula surgery
In general, no special measures are necessary. However, in some cases of complex fistulas it is necessary to rule out another pathology that manifests itself in the form of fistulas, such as Crohn’s disease or others.
It is also advisable to eat a balanced diet rich in fiber to avoid constipation.
Necessary care after anal fistula surgery
As general care, it is recommended not to be constipated and, sometimes, to make local cures on the wound. However, there are different techniques that do not require any special care. In other techniques, such as the use of glues or clips, home rest and absence of intense physical exercise for 7 days is recommended.