Our Summary

This study looked at 20 patients who had a chronic anal fissure (a tear or crack in the skin of the anal canal) along with an anal fistula (an abnormal connection between the surface of the anal canal and the skin near the anus). These conditions were treated with a surgical procedure called fistulotomy and an injection of a substance called botulinum toxin A. The study found that all patients who followed up after the treatment reported that their symptoms (which included anal pain, rectal bleeding, anal discharge, and itching) had disappeared. No patients experienced incontinence (lack of control over urination or bowel movements) or needed further surgery. The study concludes that this combined treatment seems to be effective for this condition, but more research is needed to see if treating just the fistula with fistulotomy would be as effective.

FAQs

  1. What is the surgical procedure used to treat chronic anal fissure and anal fistula?
  2. What symptoms did patients report disappearing after the combined treatment of fistulotomy and botulinum toxin A injection?
  3. Did any patients experience incontinence or require further surgery after the treatment?

Doctor’s Tip

One helpful tip a doctor might give a patient about anal fistula surgery is to follow post-operative care instructions closely to ensure proper healing and minimize the risk of complications. This may include keeping the area clean and dry, taking prescribed medications as directed, avoiding heavy lifting or strenuous activities, and attending follow-up appointments with your healthcare provider. It’s also important to communicate any concerns or changes in symptoms to your doctor promptly.

Suitable For

Patients who are typically recommended anal fistula surgery are those who have chronic anal fissures along with an anal fistula. These patients may experience symptoms such as anal pain, rectal bleeding, anal discharge, and itching. Surgery may be recommended when conservative treatments have not been successful in resolving the symptoms. It is important to consult with a healthcare provider to determine the appropriate course of treatment for each individual case.

Timeline

Before anal fistula surgery:

  • Patient experiences symptoms such as anal pain, rectal bleeding, anal discharge, and itching.
  • Patient may have been previously diagnosed with a chronic anal fissure and anal fistula.
  • Patient may have tried conservative treatments such as stool softeners, sitz baths, and topical creams without success.
  • Patient consults with a colorectal surgeon to discuss surgical options for treating the anal fistula.

After anal fistula surgery:

  • Patient undergoes a surgical procedure called fistulotomy, which involves cutting open the fistula tract to allow it to heal from the inside out.
  • Patient may also receive an injection of botulinum toxin A to help relax the anal sphincter muscle and reduce post-operative pain.
  • Patient experiences relief from symptoms such as anal pain, rectal bleeding, anal discharge, and itching.
  • Patient follows up with their surgeon to monitor healing and ensure no complications such as incontinence occur.
  • Patient reports that their symptoms have disappeared and no further surgery is needed.
  • Patient may be advised to follow a specific post-operative care plan to promote healing and prevent recurrence of the anal fistula.

What to Ask Your Doctor

  1. What is the success rate of anal fistula surgery in treating my specific condition?
  2. What are the potential risks and complications associated with anal fistula surgery?
  3. How long is the recovery period after anal fistula surgery?
  4. Will I experience any pain or discomfort during or after the surgery?
  5. Will I need to modify my diet or lifestyle after anal fistula surgery?
  6. How soon can I return to normal activities, such as work or exercise, after the surgery?
  7. Are there any alternative treatment options for my anal fistula?
  8. Will I need any follow-up appointments or additional treatments after the surgery?
  9. What is the long-term prognosis for my condition after anal fistula surgery?
  10. Are there any specific instructions I need to follow before and after the surgery to ensure the best outcome?

Reference

Authors: FitzDowse AJ, Behrenbruch CC, Hayes IP. Journal: ANZ J Surg. 2018 Jul-Aug;88(7-8):775-778. doi: 10.1111/ans.14292. Epub 2017 Dec 3. PMID: 29205737