Our Summary

This research paper is about a study that looked at what factors might increase the chances of developing an anal fistula (an abnormal connection between the inside of the anus and the skin outside) after having surgery for an anal abscess (a painful collection of pus near the anus). The study was conducted in Denmark and looked at 475 patients who had surgery for anal abscesses between 2018 and 2019.

The results showed that, after about 3 years, about one-third of the patients developed an anal fistula. The researchers found several factors that seemed to make this more likely. These included having a certain type of abscess (intersphincteric or ischioanal), having Crohn’s disease (a type of inflammatory bowel disease), having had more than one anal abscess in the past or needing to have more than one surgery, having a certain type of bacteria (E. coli) in the pus, or having a high level of a certain protein in the blood that indicates inflammation (C-reactive protein) before surgery.

The researchers believe these findings could help doctors identify which patients might need extra follow-up care after surgery, could help diagnose anal fistulas sooner in these patients, and could potentially prevent long and unnecessary treatment.

FAQs

  1. What factors were found to increase the likelihood of developing an anal fistula after surgery for an anal abscess?
  2. How might the findings from this study impact post-surgery care for patients who have had an anal abscess?
  3. What was the prevalence of developing an anal fistula after anal abscess surgery, according to the study?

Doctor’s Tip

One helpful tip a doctor might tell a patient about anal fistula surgery is to follow post-operative care instructions carefully. This may include keeping the area clean and dry, taking prescribed medications as directed, avoiding straining during bowel movements, and attending follow-up appointments to monitor healing progress. Additionally, it is important to communicate any unusual symptoms or concerns to your healthcare provider promptly. By following these recommendations, patients can help optimize their recovery and reduce the risk of complications.

Suitable For

Patients who are typically recommended anal fistula surgery include those who have:

  1. Recurrent anal abscesses: Patients who have had multiple episodes of anal abscesses are more likely to develop an anal fistula and may benefit from surgery to prevent further complications.

  2. Crohn’s disease: Patients with Crohn’s disease, a chronic inflammatory bowel disease, are at higher risk for developing anal fistulas. Surgery may be recommended to manage the fistula and improve symptoms.

  3. Specific types of abscesses: Patients with intersphincteric or ischioanal abscesses are more likely to develop anal fistulas and may require surgery for treatment.

  4. Presence of certain bacteria: Patients with specific bacterial infections, such as E. coli, in the pus from the abscess may have an increased risk of developing an anal fistula and may benefit from surgical intervention.

  5. Elevated C-reactive protein levels: Patients with high levels of C-reactive protein, a marker of inflammation, before surgery may be at higher risk for developing anal fistulas and may be recommended for surgery to address the issue.

Overall, patients who have recurrent abscesses, underlying inflammatory bowel disease, specific types of abscesses, certain bacterial infections, or elevated inflammatory markers may be candidates for anal fistula surgery to prevent complications and improve their quality of life.

Timeline

  • Before surgery: Patients may experience symptoms such as pain, swelling, redness, and drainage near the anus, indicating the presence of an anal abscess. They may undergo various diagnostic tests, such as physical examination, imaging studies, and possibly a biopsy, to confirm the diagnosis.

  • Surgery: The patient undergoes surgery to drain the abscess and remove any infected tissue. This may be done under local or general anesthesia, depending on the severity of the abscess. The surgery typically takes about 30-60 minutes.

  • Immediate post-surgery: The patient may experience some pain, swelling, and discomfort in the anal area. They will be given pain medication and instructions on how to care for the surgical site to prevent infection.

  • Follow-up appointments: The patient will have regular follow-up appointments with their healthcare provider to monitor the healing process and address any concerns or complications. They may also undergo additional tests, such as imaging studies, to check for the development of an anal fistula.

  • Development of anal fistula: If a patient develops an anal fistula after surgery, they may experience symptoms such as persistent drainage, recurrent abscesses, and discomfort in the anal area. They may undergo additional tests, such as imaging studies or a colonoscopy, to confirm the diagnosis and determine the best treatment approach.

  • Treatment of anal fistula: Treatment for an anal fistula may involve additional surgery, such as a fistulotomy (surgical opening of the fistula tract) or a fistulectomy (surgical removal of the fistula tract). The patient will have regular follow-up appointments after surgery to monitor the healing process and address any concerns or complications.

Overall, the timeline of a patient’s experience before and after anal fistula surgery involves initial symptoms and diagnosis of an anal abscess, surgery to drain the abscess, monitoring for the development of an anal fistula, and potential treatment for the fistula if it occurs. Regular follow-up care is essential to ensure proper healing and prevent complications.

What to Ask Your Doctor

  1. What is an anal fistula and why does it occur after surgery for an anal abscess?
  2. What are the risk factors for developing an anal fistula after surgery for an anal abscess?
  3. How common is it for patients to develop an anal fistula after surgery for an anal abscess?
  4. What symptoms should I look out for that may indicate the development of an anal fistula?
  5. Are there any specific tests or imaging studies that can help diagnose an anal fistula?
  6. What are the treatment options for an anal fistula and what is the success rate of these treatments?
  7. Are there any lifestyle changes or precautions I should take to prevent the development of an anal fistula after surgery?
  8. How often should I follow up with my doctor after surgery for an anal abscess to monitor for the development of an anal fistula?
  9. Are there any complications or long-term effects associated with having an anal fistula?
  10. Is there anything I can do to reduce my risk of developing an anal fistula in the future?

Reference

Authors: Skovgaards DM, Perregaard H, Dibbern CB, Nordholm-Carstensen A. Journal: Int J Colorectal Dis. 2023 Dec 13;39(1):4. doi: 10.1007/s00384-023-04576-6. PMID: 38093036