Fistula Surgery

Fistula support sub forum. Are you having, or have you had surgery for a Fistula? Or are you just looking for information? Share your experiences here, and we will help where we can.

Return to FISTULA - Are you having surgery for a Fistula or already had it?



Fistula Surgery

Postby Kim » 19 Jun 2009, 05:45

I will start here a sticky thread for all things related to fistula surgery. Not having had this type surgery myself, I'll leave it to those who have had it to please post their experience and what others might expect and need to do to recover most effectively from the procedure...
User avatar
Kim
Administrator
 
Posts: 6737
Topics: 73
Joined: 06 Nov 2006, 17:00
Has thanked: 11 times
Been thanked: 10 times
Gender: Male

Re: Fistula Surgery

Postby cherylk » 19 Jun 2009, 07:34

Another GREAT idea, Kim!! Image
cherylk
King Fissure
 
Posts: 5052
Topics: 49
Joined: 22 Apr 2008, 16:00
Location: Midwest
Has thanked: 0 time
Been thanked: 0 time
Gender: None specified

Re: Fistula Surgery

Postby derryboy » 20 Jun 2009, 03:54

Cheers kim for this.
For people that dont really know much about anal fistula here is an insight. just to get a little bit more understanding of anal fistula`s, from symptoms to surgeries, the information you read here below is from an nhs website.
--------------------------------------------------------------------
Introduction
An anal fistula is when a small, tunnel like structure (tract) develops between the back passage (anal canal) and the opening to the outer skin surrounding the anus. On the surface of the skin around the anus, one or more of the fistula ends may be seen as holes, which tunnel down into the back passage.
There are many different types of fistula, ranging from a simple, singular tract to more complicated fistulas that can be made up of several tracts which branch out. Some fistulas can be connected to the muscles that control your bowels.
An anal fistula usually develops after an anal abscess (a collection of pus) bursts. It can also form when an abscess has not been completely treated.
They can also be caused by a condition which affects the intestines, such as irritable bowel syndrome or Crohn's disease. Or a Anal Fissure (ANAL TEAR)
Most anal fistulas require surgery, as they rarely heal if left untreated. However, complications are rare, and in most cases a fistula will not develop a second time.
------------------------------------------------------------------
Symptoms of anal fistula
The symptoms of an anal fistula may include:
a throbbing, constant pain,
irritation of skin around the anus,
fever,
evidence of pus or blood when passing stools, and
generally feeling unwell.
Pain tends to worsen when you sit, move around, pass stools or cough.
If a fistula has been caused by a condition which causes inflammation of the intestines, such as irritable bowel syndrome (IBS), ulcerative colitis, diverticulitis or Crohn's disease, you may experience other symptoms such as:
abdominal pain,
diarrhoea,
loss of appetite,
weight loss,
nausea, and
vomiting.
------------------------
Causes of anal fistula
Anal abscess
Anal fistulas most commonly develop as a result of an anal abscess. An abscess is a collection of pus and infected fluid. An anal abscess normally develops after a small gland, just inside the anus, becomes infected with bacteria or foreign matter. Abscesses are usually treated with a course of antibiotics. In most cases, you will also need to have the infected fluid drained away from the abscess.
If an anal abscess bursts before it has been treated, then it can sometimes lead to an anal fistula. A fistula may also occur if an abscess has not completely healed, or if the infected fluid has not been entirely drained away.
An abscess does not always develop into a fistula. Approximately half of all people who experience an anal abscess will go on to develop a fistula. There is no way of predicting when a fistula will develop.
Anal fistulas are also a common complication of conditions that result in inflammation of the intestines. Some of these conditions include:
irritable bowel syndrome (IBS),
diverticulitis,
ulcerative colitis,
Anal Fissures
Crohn's disease,
tuberculosis,
gonorrhoea, and
cancer of the rectum
-------------------------
Diagnosing anal fistula
To make a diagnosis, your GP will look at your medical history and carry out a physical examination. Your GP will pay particular attention to any history of anal abscesses or conditions which affect your bowels, such as Crohn's disease, as these conditions can sometimes lead to an anal fistula.
When conducting a physical examination, your GP will look closely at your anal region to see if there are physical signs of a fistula. The opening of a fistula normally appears as a red, inflamed spot, which is often oozing pus. If your GP is able to locate the opening of the fistula, they may be able to make a more accurate judgement as to where the path of the fistula lies. Sometimes the path of the fistula can be felt as a hard, cord-like structure beneath the skin.
In many cases, you may have to have further testing carried out so that a more detailed look at the fistula can take place. Your doctor may use the following instruments to carry out further investigation:
Fistula probe - a fine, narrow instrument which is specifically designed to be inserted though a fistula
Anoscope - this instrument is lubricated and is passed a few inches into your rectum (the last part of the large intestine which stores solid waste). An anoscope has a light on the end, which allows the person using it to see the entire anal canal. It is also able to take small tissue samples.
If your fistula is in a complicated or unusual position, your doctor may also have to carry out further tests, which may include:
Diluted methylene blue dye - this dye is injected into the fistula and it helps to show your doctor the fistula's position and path. The dye very rarely causes any side effects.
Fistulography - this involves having a special solution injected into your fistula. You will then have an x-ray, which shows the path of the solution as an x- ray image.
Magnetic resonance imaging (MRI) scan - this scan uses magnetic and radio waves to produce detailed images of the inside of your body. This type of scan will help pinpoint the size and route of a fistula.
--------------------------------------------------------------
Treating anal fistula
The main aim of treatment for an anal fistula is to heal the fistula with as little effect on the anal sphincter muscles (the ring of muscles that open and close the anus) as possible. Damage to the sphincter muscles could cause incontinence problems in the future.
Very few anal fistulas are able to heal by themselves, so surgery is usually necessary.
Fistulotomy
The main surgical procedure used to treat a fistula is a fistulotomy. During this procedure, the surgeon will cut open the fistula, whilst you are under general anaesthetic, and then scrape and flush out its contents. The fistula is then laid open and flattened out. After 1-2 months, the fistula will heal into a flat scar. To access the fistula, your surgeon may have to cut a small portion of the anal sphincter muscle.
If the fistula is relatively simple to operate on, you may have the surgery and go home the same day. If the path of the fistula is particularly long or complicated, you may need to stay in hospital for a few days, or undergo a second stage of surgery to complete the procedure.
It can be painful to move around soon after the operation, but after approximately one week, any pain and discomfort should ease. Most people make a full recovery after two to six weeks, but if the fistula was particularly complicated, it can take up to eight weeks for it to heal completely.
Fibrin glue or collagen plug
Most cases of anal fistula will require surgery, However, in some cases you may be able to have the fistula sealed with a special type of glue made from protein. This means the fistula will not have to be cut open. The glue is injected through the opening of the fistula, and then stitched closed. A fistula can also be sealed using a small plug made of collagen and then stitched closed
-------------------------------------------------------------
Complications of anal fistula
Infection
An anal fistula rarely causes any further complications. There is approximately a one in ten chance of a fistula recurring, but with proper treatment and care, a fistula will not normally return. If complications do develop, they are usually the result of fistula surgery.
Any type of surgery carries a risk of infection, and if the fistula is not completely treated during surgery, it can sometimes cause the infection in the tract to spread to other parts of the body. If this happens you may require a course of antibiotics. If the infection is severe, you may need to be admitted to hospital so that antibiotics can be administered intravenously (through a drip in your arm).
Sphincter muscle damage
In some rare cases, surgery may damager the anal sphincter muscles (the ring of muscles that open and close the anus). If the muscles are damaged, this can lead to you losing some control of your bowels (faecal incontinence). If you already have some faecal incontinence, you may find that this worsens after fistula surgery.
derryboy
King Fissure
 
Posts: 754
Topics: 20
Joined: 23 Jan 2009, 17:00
Location: scotland u.k
Has thanked: 0 time
Been thanked: 0 time
Gender: None specified

Re: Fistula Surgery

Postby derryboy » 21 Jun 2009, 03:20

As you may have seen above, the section about Complications of anal fistula .....Infection.
i like to follow this on by giving you the following information about what is normal drainage and what might be infection of an open anal fistula wound.
----------------------------------------------------------
What Is Normal/Not Normal From Drainage of Laid open Anal Fistula Wound
================================
A lot of interesting things come out of large healing wounds, most of them are normal; some are not. Wound drainage comes in many forms and some can be alarming at first.
-----------------------------------------------------------------
Bleeding - SOME bleeding is normal, especially during packing changes. There are lots of new blood capillaries being built in your wound and those can be disturbed during packing changes. Gushing blood or large clots are not normal, call your doctor. There have been cases where an excision went too close to a larger vein and this can be scary if the vein opens up during a packing change. Anything more than about a teaspoon of blood should have a doctor look at it. For large amounts of blood that aren't stopping, go the the nearest ER. If your fistula surgey site has Sutures(stiches) bleeding one week after surgery is normal, bleeding after two weeks is not normal (unless it is from individual stitch holes that are too tight).
Exudate - This is the by-product of healing that those going through open wound healing will start seeing in the wound at about 5 days post-op. At first glance, you may think you have an infection since there will be little gobs of "gunk" in your wound. Exudate can be white, yellowish, grayish, greenish or light brown. Exudate can also have a slight odor, it is normal.
Strong odor with pain, redness and swelling usually indicates infection, call your doctor ASAP.
Exudate is a collection of dead cells and other materials discarded as your body heals itself. It needs to be gently cleaned out of the wound twice daily and this is part of role of packing changes. Exudate can be rinsed out of the wound bed with a hand-held shower sprayer, just flush the entire wound out. You may go though periods of very heavy exudate drainage (lots of healing going on) or minimal exudate drainage (healing slowing down).
Serous Fluid - Those with closed wounds should be on the lookout for Serous fluid, which is yet another interesting wound healing byproduct that the body creates to help dilute the toxins produced by bacteria and toxic products being released from dying cells. In addition, the serous fluid helps to carry plasma proteins and leukocytes to the wound site. Lastly, the serous fluid assists in removing bacterial toxins, dead cells, debris, and other products of inflammation. For those with a closed incision (sutures), this fluid can build up inside the surgical site and the drainage can be a large (scary) amount of yellow/orange fluid. Usually nothing needs to be done other than to cover the open spot to protect the clothes, but your surgeon should still be contacted because similar fluid can come out of the wound in the case of a rare but more serious wound complication.
Pus -Really bad odour smelling pus.. This is NOT normal. Pus coming from either a closed or open incision needs immediate attention from a doctor.
----------------------------------------
derryboy
King Fissure
 
Posts: 754
Topics: 20
Joined: 23 Jan 2009, 17:00
Location: scotland u.k
Has thanked: 0 time
Been thanked: 0 time
Gender: None specified

Re: Fistula Surgery

Postby derryboy » 29 Jun 2009, 03:09

Anal fistula
If you would like to know about anal fistula surgery, the reasons for the operation and the benefits of anal fistula surgery, the following information will interest you.
Before you agree to have your anal fistula operation it is important to know all you can about it. The information here is a guide to common medical practice. Each hospital and doctor will have slightly different ways of doing things when carrying out anal fistula surgery, so you should follow their guidance where it is different from the information given here. Because all patients, conditions and treatments vary it cannot cover everything. Use this information when making your treatment choices with your doctors. You should mention any worries you have. Remember that you can ask for more information at any time.
What is the problem?
You have a channel or tunnel running from inside the anus to the nearby skin. The medical name for the channel is an anal fistula. There may be more than one fistula.

--------------------------------------------------------------------------------
The fistula discharges yellow or brown liquid onto the skin. There may be attacks of pain and swelling at the skin opening and bleeding.

A fistula tracks near the anal sphincter that controls the opening of the bowel. If it runs just inside the sphincter or just through a small part of it, it is called a low fistula. If it runs from well above the sphincter, it will be right outside the sphincter and is a called a high fistula. These are important matters when treating a fistula.

What has gone wrong?
The most common cause of a low fistula is infection of a little gland just inside the anus. Instead of draining back into the anal canal, the infection burrows through the wall of the anus. It may form an abscess in the skin near the anus, called a perianal abscess. The pus may discharge through the skin.

About half of these abscesses do not heal, but go on to form a fistula. These fistulas are usually single.

--------------------------------------------------------------------------------
A high fistula is less common. The lining of the lower bowel may be affected by an inflammatory condition, called Crohn’s disease. Infection burrows through the wall of the bowel like a simple fistula, but usually from a much higher level. These fistulas are often multiple, complex and more difficult to treat. More rarely still, the cause of the fistula may be a bowel tumour.

Special tests, such as scans, a barium enema, x-rays and injection of x-ray liquids down the fistula may be needed to give more information about the problem.

The aims
The aims are to find the track of a low fistula, cut down onto it and allow it to heal. Imagine a tunnel being changed into a trench, by taking the roof off. The wound heals from the floor of the trench to form a flat scar, which may take several weeks.

The operation aims to avoid damage to the anal sphincter.

--------------------------------------------------------------------------------
A piece of the wall is taken for examination under the microscope to rule out Crohn’s disease or a tumour. You should be able to have your operation as a day case, which means you come into hospital and go home the same day.

The treatment of a high fistula aims to do the same, but is more complex, because of the anal sphincter and the underlying disease in the bowel. Sometimes it is not possible to tell before surgery the extent of the fistula and decisions are made when you are under anaesthetic.

The benefits
The discharge and bouts of pain, swelling and bleeding should stop as the fistula heals. If there is Crohn’s disease or a tumour, more treatment will be planned.

Are there any alternatives?
If you do nothing, the fistula may heal up by itself. More often, the discharge continues. Perianal abscesses may form in the same place over time.

With some very complex high fistulas, just treating the abscesses that appear from time to time may be the best treatment.

An older treatment was to pass a thread from the skin opening, through the fistula, out through the anus, and to tie the thread in a loop. The loop would pass through the tissues over several weeks. The fistula heals as the tissues also heal.
derryboy
King Fissure
 
Posts: 754
Topics: 20
Joined: 23 Jan 2009, 17:00
Location: scotland u.k
Has thanked: 0 time
Been thanked: 0 time
Gender: None specified

Re: Fistula Surgery

Postby derryboy » 29 Jun 2009, 04:13

well i had laid open anal fistula done on the 1/06/09.
4 weeks in and things feel better. the nurse is still coming in everyday to pack the wound. the packing itself stays in from anything between 5hrs to 24,
should it fall out i shower 3 x aday, no baths allowed as yet, the reason, more chance of infection lying in a bath with an open wound.
still take painkillers at night, the packing and 4 x4 gauze can cause the wound to become raw.and painfull
bleeding happens most days still, but getting less, but every so often there`s a sudden rush of blood from the area, nothing to worry about, means a good blood flow getting to the wounds which= healing.
derryboy
King Fissure
 
Posts: 754
Topics: 20
Joined: 23 Jan 2009, 17:00
Location: scotland u.k
Has thanked: 0 time
Been thanked: 0 time
Gender: None specified

Re: Fistula Surgery

Postby Kim » 29 Jun 2009, 06:57

Wow, Darren, that is all some excellent information, about your own experience and about fistulas in general!
User avatar
Kim
Administrator
 
Posts: 6737
Topics: 73
Joined: 06 Nov 2006, 17:00
Has thanked: 11 times
Been thanked: 10 times
Gender: Male

Re: Fistula Surgery

Postby derryboy » 07 Jul 2009, 03:41

web site link that i found
that pretty much sums up all about anal fistulas, from causes to treatment to recovery
http://emedicine.medscape.com/article/190234-overview
derryboy
King Fissure
 
Posts: 754
Topics: 20
Joined: 23 Jan 2009, 17:00
Location: scotland u.k
Has thanked: 0 time
Been thanked: 0 time
Gender: None specified

Re: Fistula Surgery

Postby cherylk » 07 Jul 2009, 09:19

Dazzy,
How are you?? What is that avatar you have???????
Cheryl
cherylk
King Fissure
 
Posts: 5052
Topics: 49
Joined: 22 Apr 2008, 16:00
Location: Midwest
Has thanked: 0 time
Been thanked: 0 time
Gender: None specified

Re: Fistula Surgery

Postby derryboy » 07 Jul 2009, 13:54

hi cheryl, am not to bad, cant complain. and when i could, i just try and get on with things the best i can. butts never heal quick thats for sure.
how are you. my avvy is just something i found and thought really cool. lol.
derryboy
King Fissure
 
Posts: 754
Topics: 20
Joined: 23 Jan 2009, 17:00
Location: scotland u.k
Has thanked: 0 time
Been thanked: 0 time
Gender: None specified


  • Similar Topics
    Replies
    Views
    Last post

Return to FISTULA - Are you having surgery for a Fistula or already had it?



Who is online

Users browsing this forum: No registered users and 0 guests