Fistulotomy - low fistula

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Fistulotomy - low fistula

Postby fistulotomy1984 » 06 Mar 2019, 22:59

Hello everyone,

Just like to share my experience all the way from Hong Kong.

I had an anal fissure after having BBQ and KFC. I remember having fresh blood after BM on the 16th of December. I didn't really pay attention to it and everything. It turns out to be so much pain on Christmas day and Boxing Day I had to return to HK from a Macau trip and rush to an A and E. I thought it would be an abscess as it was hard and palpable at the interior of the anal canal.

The physician attended me perform a protoscopy (painful) looking at it and said it was just a fissure. I asked him 3 times and he still said he was a fissure. He gave me all these KMNO4 sitz bath and these corticosteroid cream. This diagnosis totally delayed of me having an Incision and Drainage.

The next few days was really painful and I started having these shivers (probably sepsis). I didn't really wanted to go to the A and E again to be dismissed. Until I feel these throbbing pain and spasms that my wife dragged me to the A and E again. This time they are sure it's a full blown abscess and admit me for I and D.

I and D was performed on the New Year 2019. Pain was alleviated and for the next week or so I had wound packing from the community nurse. That was one painful procedure with questionable necessity. For the next 4 weeks, I have these healing process and wound pain that was really troublesome. On and off, pus just doesn't reside no matter how much I tried to wash the wound with alcohol, chlorhexidine. It just doesn't feel right. After a visit to the Out patient clinic for my perianal abscess, the phycisian said it's healing fine but you just never know it would turn in to a fistula.

I was happy about the progress and all and the next follow up is 8 weeks later. For the next few weeks, wound discharge just coming back and forth and won't stop until a hard swollen tissue was form under the wound. I thought it could just be a scar tissue but the pain just won't go away. After a few more visit to a normal clinical office and the A and E questioning about a fistula, I had enough and bought some Curam (1g Augmentin) for a week course. The pain did subside but it started to form a round tubular structure around the wound. It would discharge after a while and the pain will subside. If poop gets in it, it would started to get inflamed and my groin area (lymph nodes) would get swollen.

I finally had enough and search for answers online. From a well healing wound to the possibility of a fistula, it really devastating. I looked for a General Surgeon online who advertise for conducting anal fistula. A specialist is a specialist and with just one digital rectal examination, he said it's a low fistula on Mid Feb. He said you could do a fistulectomy or not, it's up to you.

The thing with a fistula is that it's not that painful and it seems to be healing on some day but inflamed on the next if some poop gets in it. I also know it's going to turn in to an abscess anytime soon if I would take care of it. So I called the surgeon and schedule a Fistulectomy on the 2nd of March, 2019. I had General Anesthesia and the surgery lasted for half an hour. It's really like a nap and the only pain I encountered was the needle injecting the Anesthetic. The surgeon reassured my fistula was low and he performed a simple fistulotomy so it shouldn't be a concern.

The next day I unpacked the dressing and there was no external wound. Probably cuz my external opening is near to the anal verge. There was some blood and all but it was a concern. The only concern was I still felt a hard palpable tissue underneath the fistula opening. Does it meant it's not cleared or potential missed secondary tract of the fistula? I immediately called my surgeon and he said it's just scar tissue. Of course, all of us with these procedures has lost faith in any doctors and still questioned whether what he said was true.

So here is my diary for post-op till today.


Post op day 1. Sunday. Pus and blood was observed with feeling of something leaking out the whole night. The scar tissue is still inflamed with pus coming out.


Post op day 2. After walking at a partk for the whole morning, heavy blood stain was observed. Pus was not observed afterward. But whenever there was BM, the scar seems to be more swollen. Sitz bath was performed. There is no more feeling of pushing of pus from the wound the night of Post op day 2.
Post op day 3. The feeling was better today. Some serum or little pus was still observed in the wound. Blood was not appeared. The wound from the scar tissue is still hard but it may want to close with the internal anal verge. Sitz bath was continued to prevent premature closure of the wound.
Post op day 4. Wound pus yellowish is seeping throughout the day. The wound is still open. Underneath is a swollen area that seems like a scar tissue. The wound would increase in sepage if some poop sticks onto the opening. Let's hope the wound would not close prematurly and the scar tissue subside in swollen as the wound closes.

Post op day 5. Discharge seems to go down at night. The wound is starting to close and merge. Pain and stinging feeling after BM. The scar tissue underneath is softer and seems to be less inflamed as the wound closes. Yellowish brownish discharge was still observed especially when the wound gets dirty.

Anyways, I would like to share a few things here after all these.

1. If you suspect to have an abscess, get incision and drainage in A and E ASAP. Fistula wouldn't likely to be formed if you get it done earlier.

2. Perianal abscess usually heals quickly. If there is any recurrent infection or recurrent abscess, it's 90% that it's going to be a fistula. Get professional help ASAP.

3. If you have a fistula diagnosed (especially a low one), get it done ASAP. I got mine done in 3 months after I and D of an abscess and it's healing nicely now.

4. If all these have to mean something, all these suffering is our body trying to tell all of us to start losing weight and get a healthy diet.

5. A fistula track is formed most likely due to insufficient drainage by the abscess in the first go. Some muscles need to be cut and the I and D for abscess usually doesn't have a clean cut leading to a fistula.

6. MRI is not necessary if you have a simple fistula. Just get someone who done these procedures often and make sure they deal of the internal opening and clear the infection from the gland with sufficient drainage.

7. Pus (yellowish discharge) after surgery is normal depends on the size of the wound. It's really not a concern. However, make sure they leaks out and doesn't trapped in any tunnel or tracks when you touch it which makes it a recurrent issue. Massage your wound multiple times daily, sitz bath with salt is enough.

Anyways, I don't have much to share with people suffering from a high fistula. But the bring home messege is just it done ASAP to prevent it from getting complicated.

Good luck for all.
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Re: Fistulotomy - low fistula

Postby fistulotomy1984 » 14 Mar 2019, 09:24

Post op day 5 to 11, I can feel the wound is zipping up. Wound drain is more or less the same as previously with a change of gauze every 2 or 3 hours. Did Sitz bath for 6 times a day. The point is gotta make it clean like everyone said. If it’s not clean, the wound gets inflammed and swollen which causes pain and the feeling of worrisome that something is going to recurrent. From my previous experience, I believe taking antibiotic in these situation is always better than not. I am now on 1g Augmenting SINCE post op day 5.

Post op day 12, this morning I feel better and pain free when I woke up which isn’t the case previously. Drainage is significant less today compare to days before. The wound is closing to the last bit which I think it can finally win the battle. I believe everything will be much better hitting the 2 weeks mark.
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Re: Fistulotomy - low fistula

Postby fistulotomy1984 » 23 Mar 2019, 03:57

Day 12 to 21, drainage was on and off. It seems to be more if I move more or after BM. Area still swollen after BM but will alleviate after sitz bath. I started a habit to take some photos everyday for progress. Up till the 3rd week post op, there is still a small dented edge in the wound which is not completely close. It’s scary especially when this is what happened last time with a hole near the anal verge and with an area underneath being painful and swollen. I guess, we all get paranoid of how long it takes to be completely healed. The difference between fistula and now perhaps it the difference in amount of drainage which is much less and pale than last time and the scar tissue underneath now is tender upon touch instead of hard and painful. Pain level is more or less the same. Anyways, let’s see how it turns out in another week. I think there will be definite answer if fistulotomy completely heals it. Wish me luck. :D
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Re: Fistulotomy - low fistula

Postby Abu » 23 Mar 2019, 05:24

Good luck! Hope you put an end to this soon.
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Re: Fistulotomy - low fistula

Postby fistulotomy1984 » 29 Mar 2019, 20:41

Thanks Abu

Today is Post-op day 28, that means 4 weeks past the surgery.
Week 4 was the week I started work again. The week began with pain and drainage and reduced in level of pain as the week goes on. I started taking videos of the wound daily. For god sake, it is recovering but slowly.

The fistula is a little longer and deeper as I expected. White epithelial tissue grows from the outside toward the inside to the end of the fistula.

Till now, drainage is still intermittent but I could manage to function without a gauze up my ass for the whole day.

The area under the wound is still lumpy and swollen after BM but not really in pain when you touch it.

Looking at the wound, the white tissue is still growing covering the wound and is less raw than the previous week. There is around 5mm of wound left to be fully cover with skin tissue. I expect 5 weeks to do the trick and clear up completely. (Hopefully, don't jinx it) I do think there fully recover is ahead and recurrence is unlikely at the moment but we will see how it goes.

Will come back at week 5 for further update! :D
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Re: Fistulotomy - low fistula

Postby fistulotomy1984 » 04 Apr 2019, 06:59

Today is post-op day 32, the wound has finally completely closed. It look such a long time. Everyday, it's getting a little better. The affected area is also getting smaller and smaller. The process had been painful particularly when poop gets in the wound (exaggerated swollen area) and you would think it's never going to heal or could there be another tract somewhere in there.

Some journal said it would take 3 to 9 weeks for completely epitheliziation. Some said 24 days. But the most accurate one came from a Taiwanese site which claim it would take around a month of time for simple fistula and at most 2 months for complex fistula. (Just to give a clue for people out there) I guess I can confidently say if any one questioning a recurrent fistula during recovery. They should ask themselves if the wound is healing and the affected size is shrinking everyday.

Although there is still some dull pain now, it is much more tolerable than previously which is noticeable for prolong sitting. Drainage has ceased completely once the wound has closed. Nevertheless, there is still a little lumpy and slight inflammation under the wound. Could be it scar tissue? No idea. Well, the problem should hopefully be resolved in another week or two.

I will probably have some celebration in the coming week and getting back to doing some exercise. (finally) 4 months of miserable and pain is a wake up call for me to eat healthy and cherish just able to get to work and be healthy. This will most likely be my last update and move on to the next chapter of my life (unless something unpredictable came along) For now, good luck to those who have to deal with this issue. I would say just get it done ASAP and just get back on recovery ASAP. God bless everyone.
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Re: Fistulotomy - low fistula

Postby Botoxgirl » 13 May 2019, 06:53

fistulotomy1984, this has been a really helpful read as I am on a similar pathway to you! Had chronic af, Botox last year didn’t work, huge abscess and infection a few weeks ago (while waiting to see the surgeon again). Ended up in emergency surgery for I&D and currently 2 weeks into healing (abscess was huge so expected to take another month to fully heal).

Saw the surgeon today who suspects a fistula has formed and will be seeing him again once healed to see whether this is the case and what to do next. Feels a bit terrifying at the moment but it’s great to hear that you are now healing well after a similar situation - thank you for sharing.
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