Recognize Swan Neck Deformity on the Fingers

Fistulotomy is one of the surgical procedures used to treat fistulas. Fistulas treated with fistulotomy have a very high cure rate, even close to 100%.

A fistula is an abnormally connected tube between two organs. One example of a common fistula is an ani fistula, which is the formation of an abnormal channel between the anus and the skin around the anus.

Recognize Swan Neck Deformity on the Fingers

Ani fistula can be caused by several things, but usually occurs because of an infection that develops into a pus-filled lump in the tissue around the anus.

Anal fistula will not heal on its own. Therefore, it requires treatment by a doctor. If an anal fistula is not treated properly, there can be a number of long-term complications that are even potentially life threatening, such as whole body infection (sepsis) and anal cancer.

To treat anal fistula, one of the treatment methods that doctors can use to do is a fistulotomy.

Purpose of Fistulotomy Surgery

The goal of fistulotomy surgery is to remove pus and fluid from the fistula ani. In this operation, the skin and muscles of the anal fistula canal that have been operated on will also be left open to allow natural healing from within.

Compared to some other surgical procedures for treating fistula ani, fistulotomy is a fairly simple procedure and low risk. causes injury to the muscles around the rectum (anal sphincter), so that the muscles can still function properly after surgery.

Fistulotomy can also be used to treat various types of fistulas, apart from anal fistulas. In fact, when used under the right indications, fistulotomy can provide a cure rate close to 100%.

Indications for Fistulotomy Operation

Fistulotomy surgery is primarily used to treat simple or mild anal fistulas ani which is located low (close to the anal sphincter muscle) and has a single hole in the skin around the anus.

Fistulotomy surgery is not performed in conditions of complex or severe anal fistulas. Anal fistula is classified as complex if:

  • Anal fistula is located above the anal sphincter muscle (where there are more muscles)
  • Anal fistula has many holes in the skin around the rectum
  • Anal fistulas arise due to radiation therapy or inflammatory bowel disease
  • Anal fistulas are connected to the female pubic tissue

Apart from complex anal fistulas, fistulotomy is also not performed on recurring anal fistula condition.

Preparation for Fistulotomy Surgery

To determine whether fistulotomy surgery is the right treatment for your anal fistula, the doctor will first perform a digital rectal examination to estimate the size and the location of the fistula in ani. To make the test more accurate, the doctor can also run other tests, such as:

Magnetic resonance imaging (MRI)

This imaging test uses radio waves and strong magnets to produce an image of the fistula tube , anal sphincter muscles, and other pelvic floor structures in detail.

Endoscopic ultrasound

This examination uses a high-frequency sound wave-producing device that is inserted into the anus to produce images of the fistula, sphincter muscles ani, and the surrounding tissue in a clear and detailed manner.

Fistulography

In fistulography, dye (contrast) fluid is inserted through the fistula opening in the skin around the anus, then a light photo is taken -X to identify the shape and size of the fistula canal.

From the results of these tests, the doctor will decide whether a fistulotomy is the most appropriate treatment method for your anal fistula condition.

In this case pe preparation before surgery, generally doctors will not give laxatives to clean the intestines from the remaining feces. However, if needed, the doctor usually gives a rectal laxative (enema) once in the morning before surgery.

The doctor will also advise you to stop eating in the middle of the night before surgery. However, you can still drink a small amount of water for up to 4 hours before the surgery. After that, you are advised not to eat or drink at all.

Fistulotomy Surgical Procedure

If your anal fistula is small and in a low position, the doctor may perform the surgical procedure using only local anesthesia. But if the fistula is large, you may need to undergo surgery under general or general anesthesia.

During the operation, the doctor will position your body based on the location of the fistula. The doctor can position you on your stomach, on your stomach with your middle body bent so that it forms an inverted "V", or on your back with your legs bent at the hip and knee at a 90 degree angle.

During the operation, the doctor will make incision from the opening of the fistula. The anus will be opened with a special instrument, then the fistula canal is opened with a scalpel. The procedure is carried out with great care to avoid damage to the anal sphincter muscle.

After the fistula canal is open, the base of the fistula is curled (scraped), then the wound is left open to heal on its own.

If necessary, the doctor will perform a marsupialization procedure, where the edges of the wound are sutured to the surrounding tissue so that the wound remains open and can increase the flow of fluid, reduce bleeding, and reduce any pain that may arise.

When the surgery is over, the wound covered and wrapped with gauze to keep it clean. Fistulotomy surgery can take from 30 minutes to 1 hour, depending on the size and location of the anal fistula.

Surgical Complications Fistulotomy

Like most surgical procedures, fistulotomy can also cause complications. Some complications can occur immediately after surgery, while others do not appear within weeks or months after surgery.

Complications that can arise after surgery include:

  • Heavy bleeding or excess discharge from the surgical wound
  • Difficulty urinating
  • Difficulty passing stools

Complications that are less frequent and generally occur within weeks or several months after surgery, among others:

  • Recurrence of fistula in ani
  • Can not hold a bowel movement
  • Narrowing of the anus, so defecating requires straining strong enough
  • The wound won't heal (after 12 weeks)

It is important to remember, fistulas in ani cannot heal on their own. Therefore, if you experience symptoms of anal fistula, such as anal pain, irritation of the anal skin, or bleeding during bowel movements, consult your doctor to confirm your condition.

If you are diagnosed suffering from an anal fistula, the doctor will perform a follow-up examination to decide whether your condition can be treated with a fistulotomy procedure.

Written by:

Sonny Seputra, M.Ked.Klin, Sp.B, FINACS

(Surgeon)

Label : Health cat_Health

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