This procedure is done in the hospital on an outpatient basis using a general anesthetic or a spinal . This procedure is done to remove a perianal fistula that can form after someone develops a perianal abscess. The fistula may form 4-6 weeks or even a year after the initial abscess. Fifty percent of abscesses will develop a fistula.
There are 3 important parts of a fistula to identify prior to or at the beginning of the surgery. The external opening, which is usually obvious around the anal opening on the outside, the tract, which is the connection between the external and the internal openings, and the internal opening, which is not always evident until during the surgery. Sometimes a blue dye is injected into the external opening to allow identification of the internal opening at the time of surgery. The fistulectomy consists of removing or opening the 3 components. This is always done with dividing the least amount of sphincter muscle as possible but yet allowing a cure of the fistula, there by minimizing any leakage or drainage after surgery. The location of the internal opening will usually dictate how much of the sphincter muscle will be cut or divided. The further up inside the anal canal or rectum the internal opening is located, the more muscle will have to be incised or cut through, leading to more of a risk of leakage or drainage after the wound has healed.
Once the fistula has been removed, the groove or wound is left open to granulate in. The granulation or healing process usually takes 4-6 weeks. The surgery takes approx. 45-60 minutes. Pain medication and antibiotics will be given at discharge. There will be several post-op office visits required.
Some fistulas can be very complicated and may require more than 1 surgery.