Is a second surgery for an anal fistula more difficult than the first one?

Written by Yu Xu Chao
Colorectal Surgery
Updated on December 29, 2024
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Relative to the initial procedure, a second surgery for anal fistula is more difficult. The main goal of anal fistula surgery is to remove the internal opening and the fistula tract completely to cure the condition. During a second surgery for an anal fistula, due to the previous operation, the internal opening may be unclear, and it can be difficult to distinguish between the fistula and scar tissue. This can lead to incomplete removal by less experienced surgeons, increasing the likelihood of the fistula recurring later. Therefore, for a second surgery on an anal fistula, it is essential to undergo the procedure in a specialized colorectal department at a provincial-level top-rated hospital. It is recommended to have a magnetic resonance imaging (MRI) of the anal region before surgery to ensure precise operation and complete removal of the internal opening and fistula tract. Proper postoperative dressing changes are also crucial to avoid infection and inflammation of the wound, which will help with normal recovery after the surgery.

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Written by Chen Tian Jing
Colorectal Surgery
1min 10sec home-news-image

What causes anal fistulas?

The most common cause of anal fistula is perianal abscess. Both anal fistula and perianal abscess involve infections at the anal crypts. Typically, an anal fistula forms naturally after a perianal abscess ruptures. Once an anal fistula occurs, it requires prompt surgical treatment. The primary surgical technique is fistulotomy with seton placement, thoroughly removing the local lesion and infection focus to allow fresh granulation tissue to regrow. Anal fistula is a local infectious disease of the anus, generally categorized into simple superficial anal fistula and high-risk complex anal fistula. If a high-position complex anal fistula is suspected, further diagnosis may require additional examination with pelvic MRI or perianal ultrasonography. After the rupture of a perianal abscess, it typically forms a characteristic internal and external opening, with a fistula tract connecting them, thereby forming the typical anal fistula.

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Written by Yang Dong
Colorectal Surgery Department
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What color is the pus from an anal fistula?

An anal fistula is a sinus tract and fistula formed from an infection of the anal sinuses and glands. During the infection phase, there is a possibility of swelling, pain, and pus discharge. This discharge may be yellow pus or pus mixed with blood. Regardless of the color, it is crucial to seek prompt medical treatment at a hospital and undergo thorough treatment, rather than attempting conservative treatment on one's own.

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Written by Yang Dong
Colorectal Surgery Department
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Is the probability of anal fistula turning into cancer high?

An anal fistula, formed due to an anal gland infection, carries a higher risk of malignant transformation if the infection and inflammation are recurrent and persistent, particularly over a long period exceeding five years. Therefore, it is strongly recommended that anal fistulas exceeding five years should be given sufficient attention and surgical treatment should be pursued promptly to prevent malignancy.

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Written by Chen Tian Jing
Colorectal Surgery
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Can anal fistulas be left untreated indefinitely?

If a patient is diagnosed with an anal fistula, it must not be left untreated. If an anal fistula is not actively treated over a long period, it can easily lead to thickening of the fistula tract or an increase in branching. Moreover, after long-term repeated inflammatory stimulation, some fistula tracts are prone to malignant transformations. Therefore, it is recommended that patients with anal fistulas seek symptomatic treatment as soon as they are diagnosed. The primary method of treating anal fistulas is surgical. The main surgical approach for an anal fistula is fistulotomy with seton placement, which involves removing the local fistula tract wall while preserving the function of the patient's sphincter muscle. After the surgery, patients need to follow a light diet to avoid an increase in local secretions, which can lead to inflammatory stimulation and even the recurrence of the anal fistula.

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Written by Chen Tian Jing
Colorectal Surgery
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How to cure anal fistula completely

The radical treatment of anal fistula mainly involves surgery, with the choice of surgery being the anal fistula cutting and ligation operation. This primarily utilizes a ligature or elastic band to loop through the local sphincter, thereby achieving slow cutting and drainage of secretions. Anal fistula is considered a local infectious lesion at the anus, and the fundamental principle of the surgery is to remove the local fistula tract and the wall of the fistula completely through cutting and ligation, and after thoroughly removing the local infection, fresh granulation tissue can regrow. Due to the prolonged location of the local lesion in anal fistulas, postoperative wound dressing and drainage are very important. The wound can be disinfected daily with povidone-iodine, and gauze impregnated with oil can be used for pressurized drainage to help facilitate the flow of local secretions.