Our Summary

This study reviewed and analyzed different surgical methods for treating a severe type of anal fistula (an abnormal connection between the surface of the anal canal and the skin). The researchers looked at 48 different trials involving 4205 patients. They found that a surgical method called the Incision Thread-Drawing Counter-Drainage Procedure (ITCP) had the best results in terms of improving the effectiveness and cure rates, reducing the chance of the condition coming back, and minimizing damage to the anal canal. Another method, the Directional Line-Hanging Method (DLM), was found to be the safest and best for relieving pain after surgery. The Sphincter Preserving Thread-Hanging Method (SPTM) was found to speed up the healing of the wound. Overall, they found that these thread-drawing surgical methods were effective for treating severe anal fistulas, but they noted that more research is needed to confirm these findings.

FAQs

  1. What is the most effective surgical method for treating severe anal fistulas according to the study?
  2. Which surgical method was found to be the safest and best for relieving post-operative pain in severe anal fistula cases?
  3. What are the benefits of the Sphincter Preserving Thread-Hanging Method (SPTM) in anal fistula surgery, as per the study?

Doctor’s Tip

A helpful tip a doctor might give a patient undergoing anal fistula surgery is to follow post-operative care instructions closely, such as keeping the area clean and dry, taking prescribed medications, and avoiding strenuous activities that could disrupt the healing process. Additionally, it is important to attend all follow-up appointments to monitor the healing progress and address any concerns or complications that may arise. Remember to communicate openly with your healthcare provider about any symptoms or changes you experience during the recovery period.

Suitable For

Patients who are typically recommended anal fistula surgery are those who have severe anal fistulas that are causing symptoms such as pain, swelling, and discharge. These patients may have tried other treatments such as antibiotics or drainage procedures without success. Surgery may be recommended if the fistula is complex, deep, or has multiple tracts, as these types of fistulas are less likely to heal on their own. Additionally, patients who have recurring anal fistulas or those with underlying conditions such as Crohn’s disease may also be candidates for surgery. Ultimately, the decision to undergo anal fistula surgery is based on the individual patient’s symptoms, the severity of the fistula, and the likelihood of successful treatment with surgical intervention.

Timeline

Before anal fistula surgery:

  1. Patient experiences symptoms such as pain, swelling, discharge, and discomfort around the anal area.
  2. Patient consults with a healthcare provider who confirms the diagnosis of an anal fistula through physical examination and possibly imaging tests.
  3. Healthcare provider discusses treatment options with the patient, including surgical methods like ITCP, DLM, and SPTM.
  4. Patient undergoes pre-operative preparation, which may include fasting, bowel preparation, and receiving instructions on post-operative care.

After anal fistula surgery:

  1. Patient undergoes the selected surgical method, such as ITCP, DLM, or SPTM, to treat the anal fistula.
  2. Patient may experience pain, discomfort, and swelling in the anal area immediately after surgery.
  3. Patient receives post-operative care instructions, including wound care, pain management, and follow-up appointments.
  4. Patient may experience improvements in symptoms such as reduced pain, swelling, and discharge as the wound heals.
  5. Patient follows up with their healthcare provider for monitoring and evaluation of the surgical outcome.
  6. Patient may need additional treatments or procedures if the anal fistula does not heal properly or if complications arise.

What to Ask Your Doctor

  1. What type of anal fistula do I have and what are the potential risks and benefits of surgery for my specific case?
  2. What are the different surgical options available for treating my anal fistula and which one do you recommend for me?
  3. How experienced are you in performing anal fistula surgeries and what is your success rate with this procedure?
  4. What is the expected recovery time after surgery and when can I resume normal activities?
  5. What are the potential complications or side effects of the surgery and how can they be managed?
  6. Will I need any additional treatments or follow-up care after the surgery?
  7. How likely is it that my anal fistula will come back after surgery and what can I do to prevent recurrence?
  8. Are there any lifestyle changes or modifications I should make before or after surgery to improve the outcome?
  9. Can you provide me with information about support groups or resources for patients undergoing anal fistula surgery?
  10. Are there any alternative or non-surgical treatment options available for my anal fistula?

Reference

Authors: Zhang H, Lin M, Nan Z, Zhang Y, Liu S, Li A, Li G. Journal: Int J Colorectal Dis. 2023 Sep 14;38(1):228. doi: 10.1007/s00384-023-04519-1. PMID: 37707561