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Dr Uzair
Dr Uzair, Doctor
Category: Medical
Satisfied Customers: 7627
Experience:  MBBS, FCPS (R) General Surgery. Years of experience in Emergency Medicine.
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I had a simple fistulotomy 10 days ago. I have no packing---

Resolved Question:

I had a simple fistulotomy 10 days ago. I have no packing--- my physician said it was very superficial-- he just went into rectal wall and made a canal so that fistula could heal from inside out. Can you explain the healing process? How can this heal when there is fecal matter draining from fistula after every bowel movement? and in a healthy person how long is the usual recovery time?
Submitted: 6 years ago.
Category: Medical
Expert:  Dr Uzair replied 6 years ago.

Hi. Welcome to JustAnswer. I shall try my best to assist you while you are corresponding with me.

This is called, 'Laying open of the fistula' (Fistulotomy). Remarkably, this heals even in the presence of fecal matter and without any need to change or apply new dressings.

For deeper fistulas and complex fistulous tracts some surgeons perform a defunctioning or diversion colostomy to divert the fecal matter away from the fistula. This is not routinely done for simple (superficial) fistulas.

The healing process is simple, the granulation tissue (baby tissue) here in this region forms very early, within a couple of days due to a very rich blood supply. Granulation tissue is known to have the strongest resistance to infection and this is a very good example.

Your physician would have advised you to take "Sitz baths". These are done by sitting simply in a tub full of luke warm water admixed with one to two table spoons of povidone-iodine or some other antiseptic solution. This is done for 15 to 20 minutes, three or four times a day especially after a bowel movement. This cleans the area of any bacteria that can invade.

If the canal is superficial, it will take 2 weeks approximately (sometimes 3 weeks) for the area to heal completely. Healing rates vary from person to person. But on the average it takes 15 to 20 days as I mentioned.

Hope this helps.

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Customer: replied 6 years ago.

ok--- thank you!!! Will the fecal matter drainage stop before the area is actually healed? And what is the next step if this does not heal? Does this type of fistulotomy usually have a positive outcome?

Expert:  Dr Uzair replied 6 years ago.

Thanks for the reply.

Yes, the general rule in Surgery is, that without distal obstruction to the flow, any abnormal fistula will stop and heal spontaneously - the thing with Fistula in ano is that the fistula has matured that is why it needs surgical intervention and once that is done, and the tract opened and refreshed, it should heal according to principle.

There is a chance of recurrence with Fistula in Ano - partly owing to poor surgical technique, inadequate care by the patient or constipation. But if so, there are a lot of options to consider - Advanced Fistulotomy, Fistula plugs, Advancement flaps, glue injections and diversion colostomy. With more chronic or high laying fistulas a seton fistulotomy can be done. The decision for other surgical options rests with the surgeon and the patient. Most of the options I have mentioned have very good outcomes.

Hope this helps.
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