An anal fistula is a narrow tunnel or tract running from the skin near the back passage and opening into the anal canal higher up. This discharges pus irregularly and may be uncomfortable. It often shows up after there has been an abscess near the anus.
During the operation, the fistula tract is identified and is opened along its length, and the exposed inside of the tract is then cleaned out. The wound is usually left open without suturing it. The wound becomes shallower as it heals and ends up as a flat scar after a month or two. If it is too deep a drain can be placed and may need to be removed in a second operation.
- There is a chance of damage to the circular anal muscle. If the tunnel is found to run through the sphincter muscle, it would be unsafe to cut it open because the muscle would be damaged. In such a case the surgeon may choose to thread a thin plastic tube along its length, and this is called a seton. This seton will then be left in the fistula tract to keep it open and allow drainage and promote healing. The seton would typically stay in position for 9 to 12 weeks after which it need a second operation to remove the tunnel along the seton.
- Later complications may occur such as an anal stricture or narrowing of the anal opening. The chance of another fistula forming later, is about 10%.
After your consultation:
- Obtain authorization from your medical aid and book your bed for your hospital admission.
- Carefully read through pre-operative information provided.
Day before surgery:
- Do not eat/drink after 22h00, the night before your surgery, unless otherwise specified by your surgeon or anaesthetist (you should be fasting for at least 6 hours before the procedure for solids but you are allowed to take clear liquids up to two hours before your procedure).
Day of surgery:
- Arrive for admission at indicated time on ‘Code & Consent’ sheet.
- Change into theatre attire, remove all valuable belongings.
The time the procedure takes varies but on average takes around 45 minutes.
Duration of hospital stay:
- Usually 1 – 2 days (dependent on post-operative progress of patient)
- 24 hours after surgery
Back to work:
- Sick leave required post-operatively is approximately 7 – 10 days in total
Some pain and discomfort post operatively may be expected following any operation, but the following measures are used to lessen the pain experienced:
- Warming devises in theatre as well as warm intravenous fluids.
- Intra-operative pain medication through the drip.
- Post-operative medication through the drip, please inform the nurses if you are in pain so that medication will be administered to you.
- As close to one week after discharge as possible. Please contact the rooms to schedule an appointment.