Type of Surgery
Last updated: 01/20/2010
A fistula is an abnormal connection between two organs or tissues. A fistula can occur virtually anywhere in the body, but it most often occurs between the intestine and some other structure. The fistula can be thought of as a tunnel and common fistulae connect the intestine with a later part of the intestine, intestine with urinary bladder, intestine with the vagina in women, or intestine can even break through to the surface of the skin. Obviously these tunnels can be troubling to patients and require surgery to correct them. One of the most common performed procedures to correct fistulae is a fistulotomy.
If a fistule is thought of as a tunnel, a fistulotomy is simply a cutting open of the tunnel lengthwise. The tunnel is cut end to end to form a groove or channel instead. When the fistulotomy is performed in this manner, the abnormal tissue is able to heal. The alternative approach is a fistulectomy in which the entire fistula is removed. Perhaps surprisingly, a fistulotomy surgery is the better option for most patients. The scar from a fistulotomy procedure is smaller than a fistulectomy and recovery is shorter with fistulotomy. The recurrence rates are about the same in both surgical techniques.
In most cases a seton may be used during the fistulotomy. A seton is a thread that is passed through the length of the fistula. This helps identify the length and extent of the abnormal tract and can also be used to cut the tract open. By using a seton that has certain properties, once in place the seton can be used to cut through the fistula.
A fistulotomy procedure can be performed under general anesthesia, local anesthesia with an intravenous sedative, or a regional block. The regional block is similar or precisely like an epidural used to numb the lower half of the body during pregnancy delivery. Since the fistulotomy surgery potentially takes place in very sensitive areas, the surgical field is injected with local anesthetic at the end of the procedure to reduce postoperative discomfort.
Since a fistulotomy surgery usually involves the intestine, controlling infection is extremely important. The bowel must be thoroughly prepared through the use of enemas and oral agents that promote defecation. During surgery, the area is flushed with sterile fluids that contain antibiotics. Antibiotics may be administered before, during, and after the fistulotomy procedure.
Fistulotomy recovery primarily involves keeping the region clean and dry and making sure that the bowels move easily and regularly. Often a patient that has had a fistulotomy will be required to take Sitz baths for a period of time. This promotes healing and minimizes the risk of infection. Also, patients will be encouraged to eat a fiber rich diet (bran, psyllium husk) in order to keep the stool smooth and regular. The goal is to prevent excessive straining during defecation, which would interfere with the fistulotomy closure and sutures. Depending on the patient's individual comfort level, fistulotomy recovery may be as short as six weeks though a return to work and normal activities may be sooner.
Last Updated: 01/20/2010
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