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A fistulotomy is a surgical procedure that is performed to correct anal fistulas. A fistula is a small, sometimes painful channel that splits from the anal cavity, buries within muscle tissue, and emerges through the skin near the anus. The only reliable treatment for fistulas is fistulotomy, and most patients who are diagnosed with the condition eventually need the surgery to prevent major infections and chronic symptoms. During the procedure, a surgeon cuts the channel open, spreads it out flat, scrapes away pus and infected tissue, and sutures it to surrounding muscle tissue to prevent recurrence. Most fistulotomy procedures can be performed in less than an hour in an outpatient surgery center, and the success rate is very high.
Before considering a fistulotomy, a doctor reviews the patient's full medical history to make sure that he or she is a good candidate. People who suffer from Crohn's disease and other irritable bowel disorders typically do not respond well to surgery because their conditions make it tough for tissue to heal afterward. Such patients may be prescribed antibiotics and scheduled for regular checkups to see if their fistula symptoms improve. Most other people who are in generally good health are scheduled for surgeries.
A fistulotomy involves a small amount of cutting and probing into an very tender, inflamed area. Most surgeons suggest that patients receive general anesthesia before their procedures to reduce pain and stress. An anesthesiologist provides sedatives and painkillers about thirty minutes before the surgery begins and monitors vital signs throughout the operation to ensure the patient is comfortable. The sedated patient is usually positioned on his or her stomach with the buttocks slightly elevated. The skin around the anus is then sterilized and prepared for surgery.
A probing device is inserted into the anus and used to locate the internal opening of the fistula. Once the surgeon determines the exact size, location, and path of the fistula, he or she can begin cutting it open with a scalpel or cauterizing tool. Depending on the location, it may be necessary to sever the sphincter muscle wall to gain access. Pus, fecal waste, and remnants of dead and inflamed tissue are carefully scraped out of the fistula. Remaining tissue is often sutured or glued to the sphincter to ensure the fistula does recur.
Following a fistulotomy, topical antibiotics and dressing are applied to prevent bleeding and infection. The patient is brought to a recovery room until the anesthesia wears off. He or she is usually prescribed antibiotics and painkillers and given instructions about caring for surgical wounds at home. A person can expect some discomfort with sitting and bowel movements for about a month during recovery. A follow-up doctor's visit can confirm the procedure was successful and that healing is taking place.