Background Information:

What are the other Names for the Procedure?

• Anal Fistula Operation

What is Anal Fistula Repair surgical procedure?

• An anal fistula is an abnormal opening formed from within the inner lining of the rectum or anal canal to the outside skin around the anus
• Anal Fistula Repair is a procedure that involves the surgical opening of the anal fistula, which helps in the healing process of the fistula

What part of the Body does the Procedure involve?

Anal Fistula Repair involves the rectum, the anus, and tissues around both these regions.

Why is the Anal Fistula Repair surgical procedure Performed?

Anal Fistula Repair is performed to treat the fistula, which is usually due to an underlying infection or abscess in that region. By surgically opening the fistula, the underlying infection will be treated as well.

What are some Alternative Choices for the Procedure?

A few alternative choices for Anal Fistula Repair are:

• Seton Placement
• Fibrin Glue and Collagen Plug
• Advancement Rectal Flap
• Ligation Intersphincteric Fistula Tract (LIFT procedure)

What are the Recent Advances in the Procedure?

Ligation Intersphincteric Fistula Tract (LIFT) is a recent and advanced technique used to treat anal fistulas.

What is the Cost of performing the Anal Fistula Repair surgical procedure?

The cost of Anal Fistula Repair procedure depends on a variety of factors, such as the type of your health insurance, annual deductibles, co-pay requirements, out-of-network and in-network of your healthcare providers and healthcare facilities.

In many cases, an estimate may be provided before the procedure. The final amount depends upon the findings during the surgery/procedure and post-operative care that is necessary.

When do you need a Second Opinion, prior to the Procedure?

• It is normal for a patient to feel uncomfortable and confused by the information regarding Anal Fistula Repair and on what needs to be done
• If the patient needs further reassurance or a second opinion, a physician will almost always assist and also recommend another physician, if required
• They can also choose to approach another physician independently. Besides, if the procedure has many alternatives, the patient may take a second opinion to understand and choose the best one

What are some Helpful Resources?

http://www.bupa.co.uk/individuals/health-information/directory/a/anal-fistula-repair#textBlock200218

http://www.mayoclinic.org/anal-fistula/treatment.html

Prior to Anal Fistula Repair surgical procedure:

How is the Anal Fistula Repair surgical procedure Performed?

• Anal Fistula Repair is performed under local anesthesia, spinal anesthesia, or general anesthesia
• The surgeon examines the anal opening of the patient with the help of a probe called an anoscope, which helps locate the interior end of the fistula in the anal canal
• In case an abscess formation is observed; an incision is made to open the tissue including the skin around the fistula and the abscess is drained
• Incision wound is then left open, to permit the wound to heal from inside out

Where is the Procedure Performed?

An Anal Fistula Repair is performed in an out-patient surgery center facility or a hospital. If the fistula is small, the procedure can also be performed at a physician’s office; if it is suitably equipped to handle such procedures.

Who Performs the Procedure?

The surgery is normally performed by a general surgeon with assistance from an anesthesiologist.

How long will the Procedure take?

The procedure takes less than an hour. However, when fistulas are difficult to locate, the time period may increase.

What do you need to tell your Physician before the Procedure?

It is very important to provide the following information to your healthcare provider. This enables your healthcare provider in assessing the risks for the surgical procedure and helps avoid unnecessary complications.

• Provide a complete list of medications you are currently, taking to your physician. This information is useful for a variety of reasons. For example, it can help your healthcare provider prevent complications due to a drug interaction
• If you are allergic to any specific medication or food items
• If you are taking blood thinners, such as aspirin, warfarin, herbal supplements, or any other such medications
• If you or your family members, have a history of bleeding disorders, or if there is a tendency to bleed more than normal
• If you have diabetes, high blood pressure, chest pains, or have previously suffered from a heart attack
• If you have ever been diagnosed with blood clots in your leg (deep vein thrombosis) or lung (embolism of lung)
• If you have a history of frequent bone fractures (this may affect bone-healing, if bones are involved as part of your procedure)
• A list of all previous surgical procedures you have undergone, like for example: Removal of appendix, gallbladder, or any other part, of your body; surgical repair of any body part, such as hernia repair, perforation of bowel wall, etc.

What Preparations are needed, prior to the Procedure?

• No particular preparations are needed prior to an Anal Fistula Repair
• However, the physician may evaluate the individual’s medical history to gain a comprehensive knowledge of the overall health status of the patient including information related to the medications that are being currently taken
• Some medications increase a person’s chances of bleeding and it may be recommended to discontinue them for a period of time, before the procedure is performed
• Blood tests may be performed to determine if there is a bleeding tendency or any other medical conditions that prevents the person from undergoing the procedure
• Since local anesthesia is normally used; do inform the physician if you are allergic to any local anesthetics, lidocaine, etc.
• Avoid application of any cosmetics, deodorant, or topical medicines on the area, prior to the procedure
• It is advisable to quit smoking and the use of any nicotine based products, for a while, before the surgery
• Consumption of alcoholic drinks must also be avoided for a period of time, as instructed
• The patient must avoid eating or drinking at least 8 hours prior to the surgical procedure, depending on when the procedure is arranged
• For persons suffering from diabetes, it is important that the blood sugar stays within the normal range; if not their diabetologist may have to control blood sugar by recommending insulin and/or a combination of oral medicines

The physician will request your consent for the Anal Fistula Repair procedure using an informed Consent Form. 

What is the Consent Process before the Procedure?

The physician will request your consent for the Anal Fistula Repair procedure using an informed Consent Form.

Consent for the Procedure: A “consent” is your approval to undergo a procedure. A consent form is signed after the risks and benefits of the procedure, and alternative treatment options, are discussed. This process is called informed consent.

You must sign the forms only after you are totally satisfied by the answers to your questions. In case of minors and individuals unable to personally give their consent, the individual’s legal guardian or next of kin, shall give their consent for the procedure.

What Tests are needed, before the Anal Fistula Repair surgical procedure?

• No particular tests are generally needed before the procedure
• The surgeon may use a fistula probe or an anoscope to locate the fistula. If the fistula is difficult to locate; the surgeon may recommend a magnetic resonance imaging, endoscopic ultrasound, or a fistulography

What are some Questions for your Physician?

Some of the basic questions that you might ask your physician are as follows:

• What is an Anal Fistula Repair?
• What are the available surgical and non-surgical options to treat anal fistula?
• Do I need to undergo a surgery? Can oral medication solve the problem?
• What does the procedure involve?
• How soon should I get it done? Is there an emergency?
• Who are the medical personnel involved in this procedure?
• Where is the procedure performed?
• What are the risks while performing the procedure?
• What are the possible complications that might take place, during recovery?
• How long will it take to recover? When can I resume normal work?
• Is there a possibility that the fistula might form again?
• How many such procedures have you (the physician) performed?
• Are there any follow-up tests, periodic visits to the healthcare facility required, after the procedure?
• What are the costs involved?

During the Anal Fistula Repair surgical procedure:

What kind of Anesthesia is given, during the Procedure?

Generally, a local anesthesia or a spinal anesthesia is given. Infrequently, for a few cases general anesthesia may require to be administered.

How much Blood will you lose, during the Procedure?

The amount of blood loss is generally minimal. If complications arise during the procedure, it could lead to a further loss of blood.

What are the possible Risks and Complications during the Anal Fistula Repair surgical procedure?

The possible risks and complications that may arise during the surgery are:

• Excessive bleeding
• Surgical wound infection
• Accidental damage to the sphincter muscles 

What Post-Operative Care is needed at the Healthcare Facility after the Anal Fistula Repair surgical procedure?

At the healthcare facility, generally there is no requirement for any post-procedure care, unless any complications arise.

After the Anal Fistula Repair surgical procedure:

What are the possible Risks and Complications after the Anal Fistula Repair surgical procedure?

The possible risks and complications that may arise after Anal Fistula Repair are:

• Recurrence of the anal fistula
• Surgical wound infection
• Incontinence

What is the Prognosis after the Surgery?

• The general prognosis post Anal Fistula Repair procedure, is usually good
• It has been noted that in 30% of the cases post-surgery, the patient suffers from minor incontinence

When do you need to call your Physician?

Do contact your physician if you notice any of the following symptoms:

• Redness, pain or swelling around the surgical wound
• Drainage from the surgical wound
• Signs of infection
• Dizziness
• Constipation
• Nausea

What Post-Operative Care is needed at Home after the Anal Fistula Repair surgical procedure?

At home, the following post-operative care is recommended, after an Anal Fistula Repair procedure:

• Take sitz baths 3-4 times a day
• Change bandages every 4-5 hours
• Complete the prescribed course of antibiotics and oral medication
• Do take complete bed rest, per advise from your physician
• Elevate your legs while resting, in order to prevent blood clots in the legs
• Wash the anal area thoroughly with soap and water after bowel movements
• Consume only liquids and/or semi-solid foods for a certain period of time, as advised
• Take stool softeners to prevent constipation
• Avoid any strenuous activity for 3-4 weeks after the surgery

How long does it normally take to fully recover, from the Procedure?

It may take anywhere between 4 to 6 weeks to completely recover from an Anal Fistula Repair surgery. This period is also dependent upon the size of the fistula treated.

Additional Information:

What happens to tissue (if any), taken out during the Procedure?

Anal Fistula Repair does not involve the surgical removal of any tissue.

When should you expect results from the pathologist regarding tissue taken out, during the Procedure?

Since no tissue is removed during the procedure, a pathologist does not get involved in the care of the patient.

Who will you receive a Bill from, after the Anal Fistula Repair surgical procedure?

It is important to note that the number of bills that the patient may receive depends on the arrangement the healthcare facility has with the physician and other healthcare providers. 

Sometimes, the patient may get a single bill that includes the healthcare facility and the consultant physician charges. Sometimes, the patient might get multiple bills depending on the healthcare provider involved. For instance, the patient may get a bill from:

• The outpatient facility or hospital
• A general surgeon
• An anesthesiologist (if anesthesia was administered)

The patient is advised to inquire and confirm the type of billing, before Anal Fistula Repair is performed.

Thanks and Gratitude:

We sincerely acknowledge and thank Dr. Douglas J. Jones for reviewing the article. His valuable input and feedback has helped enrich the contents of this article.

Douglas J. Jones, MD FACS
Board Certified General Surgeon and Faculty Member
University of Illinois, College of Medicine at Urbana-Champaign
506 S. Mathews Ave., Urbana, IL 61801, USA