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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How to deal with a ruptured anal fistula?

The clinical symptoms of anal fistula mainly include intermittent discharge of pus from the external opening near the anus, or occasional acute attacks that cause redness, swelling, heat, and pain around the external opening of the anus. If the external opening of the anal fistula breaks and discharges pus, or is accompanied by pain, it is considered an acute phase of the anal fistula. The primary method of management and treatment is surgery, with the main surgical approach being fistulotomy and seton placement. To locally alleviate the inflammatory symptoms of the external opening of the anal fistula, anti-inflammatory ointments can be applied for temporary anti-inflammatory treatment. However, to avoid the local complications such as thickening or branching of the fistula, it is advised that patients undergo surgical treatment of the anal fistula as soon as possible. (Please use medication under the guidance of a professional physician, and do not self-medicate.)

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The difference between perianal abscess and anal fistula

Perianal abscesses and anal fistulas both belong to local infectious diseases of the anus. A perianal abscess represents the acute phase of infection, characterized by significant localized subcutaneous swelling, heat, pain, and the formation of pus and abscesses. Once the pus breaks through the skin and discharges, it naturally forms an anal fistula. Anal fistulas represent the later stages or dormant phases of local infections. Both perianal abscesses and anal fistulas require surgical treatment. The surgical method for perianal abscesses mainly involves a one-time radical surgery for the abscess, while the surgical approach for anal fistulas primarily involves fistulotomy with seton placement, followed by regular wound cleaning and dressing changes post-surgery.

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Does an anal fistula require surgery?

The treatment of anal fistula mainly focuses on surgical treatment, with medication as a secondary support. This means that without surgery, an anal fistula essentially cannot heal. Non-conservative treatments for anal fistulas are only temporary symptomatic treatments that manage the condition and alleviate clinical symptoms. For example, during an acute attack of an anal fistula, anti-inflammatory drugs can be used to temporarily relieve symptoms such as pain. Therefore, surgery is necessary for anal fistulas, as surgical treatment can completely eradicate the source of the disease, addressing the internal and external origins of the fistula for a complete cure.

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What are the symptoms of anal fistula?

The clinical symptoms of anal fistula are mainly manifested as intermittent discharge of secretion from the local external opening near the anus, accompanied by varying degrees of pain in the anal area, and occasionally, pus is expelled with the stool. The main reason for its formation is that the anal fistula not only has an external opening, but also an internal opening near the dentate line of the anal canal. The internal opening discharges pus intermittently due to the stimulation of local inflammation. The composition of an anal fistula includes the internal and external openings, as well as the fistula tract that connects them; therefore, simply using medication cannot completely eliminate this lesion. The treatment of anal fistula is mainly surgical, aimed at removing the local lesion, with the principle of preserving the anal sphincter to avoid damage to it, which could affect the patient's future life.

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Can colitis cause anal fistula?

If it is chronic colitis, it is possible to cause anal fistulas. Most patients with chronic colitis have symptoms of unformed stools and loose feces. Some feces, which are relatively thin, tend to accumulate in the anal crypts, leading to infection of the anal glands in these areas. The inflammation then spreads to the normal soft tissues around the anus, including subcutaneous tissues, forming perianal abscesses. If a perianal abscess ruptures or is surgically incised to release pus, the external opening and the pus cavity gradually heal and narrow, thus forming an anal fistula. If chronic colitis is diagnosed, it should be promptly diagnosed and treated to prevent the formation of anal fistula.