Abnormal connections formed between various organs or tissues are termed as fistulas. They may develop by birth or acquired later in life due to injury. The commonly observed fistula include
- Anorectal fistula – connection between anus or rectum and the surrounding tissue. In women vagina may be connected to the anus or rectum.
- Arteriovenous fistula: connection between arteries and venous that disturbs the normal blood flow supply.
Tracheoesophageal fistula: Esophagus and trachea are connected. As a result choking and breathing problems develop.
Connections of organs or tissues is often life threatening as it disturbs the normal processes. Hence, they should be diagnosed and repaired to reduce the risk of mortality. Abnormal connection is generally closed or repaired by performing fistula surgery.
Performing fistula surgery
Before performing the surgery, the surgeon will identify the exact location and type of the fistula. A connection may be a single connection or a connection can be branched forming more number of openings. Digital scanning and x-rays will be used to know more about the fistulas.
Different types of fistula surgery depending on the type of fistula
- Fistulotomy: Superficial fistulas are repaired using this procedure. In this surgical procedure fistula both interior exterior openings of the fistula are opened to drain the contents of fistula completely. It is then left to heal. After two to three months fistula heals as a flat scar. In few cases, a surgical thread termed as seton will be left in the tract of the fistula. The seton helps in complete draining of the fistula contents before healing. Seton is also used for the healing of secondary tracts before operating on main tract.
- Advancement flap procedure: This fistula surgery is used to repair complex fistulas. In this procedure the fistula is removed and then advancement flap is placed at the position of fistula opening.
- Bioprosthetic plug: In this procedure a plug is made from human tissue and placed at the point where the fistula opens interiorly by using stitches. The bioprosthetic plug then blocks the fistula opening leaving the exterior opening open. Pus and other contents of the fistula drain through the exterior opening before the fistula and the sutures around the plug heal. Rare disadvantage with this procedure displacement of the plug.
Post fistula surgery care
After the surgery, the patient should remain hospitalized for about ten days until the wound starts to heal without complications.
- Pain medications should be used to relieve pain.
- Taking liquid diet.
- Appropriate dressing of the wound to prevent infections.
Complications of fistula surgery
- Anorectal fistula repair may cause incontinence. However, an experienced surgeon can cut the tissue appropriately and prevent incontinence of stools.
- In few cases, recurrence of fistula is also observed. For example, surgical removal of fistula in patients with crohn’s disease is useful. But, if the crohn’s disease is not treated it results in recurrence of fistula.
- Infections may develop at the site of surgery if proper care is not taken until the wound heals completely.
Alternatives to fistula surgery
In few cases, surgery may not be performed due to presence of recurring fistulas such as the rectovaginal fistula and perianal fistula. In such cases, alternative treatment strategies such as sitz bath and use of natural oregano oil that prevents bacterial infection can be used manage the fistula. Sitz bath helps to improve blood circulation and soothe the irritated area.