Fistula and Anal Fissure Surgery
The majority of people have difficulties in going to the toilet, but the long-term persistence of constipation leads to medical problems. Fistula and anal fissure surgery is preferred for the treatment of tears in the anus area due to constipation or diarrhea. Pain in the anus area after toilet, bleeding to indicate crack, or the presence of a feeling like a glass cut while defecating indicates anal fissure.
What is Fistula and Anal Fissure?
A fistula is an abnormal connection between an organ and another structure. Tubular fistula may be the connection of two cavities in the body such as the vagina and bladder, or it may develop between the skin tissue and the body cavity. Fistula is commonly observed in and around the anus. The second most common location is between the two parts of the intestines, called enteroenteric fistula. In addition, fistula formation may occur in the urinary tract.
Nerve endings in the rectum make the area extremely sensitive. For this reason, excessive straining due to constipation and similar reasons leads to ruptures in the anus. Anal fissure means anal fissure in medical literature. In general, when the patient lies on his back, it is observed in the anoderm in the weakest part of the breech, located at 6 o'clock.
With the formation of the tear in the anus, the healing cells in the body are activated in the region immediately. However, re-defecation before the healing is complete prevents the wound from closing.
Fistula and Anal Fissure Which Area?
For the diagnosis and treatment of fistula and anal fissure, patients should refer to the general surgery department. General surgery is an extremely broad field and the unit of breech diseases is called proctology. The proctologist performs a physical examination of the patient and listens to his/her history. An anal fissure occurs near the anus and can be seen with the naked eye. Therefore, it can be diagnosed directly by the physician during the examination.
The general surgeon can also determine the extent of the disease. Anal fissure can occur in two forms, chronic or acute. Acute anal fissure refers to the first 15 days after the occurrence of the discomfort. In chronic anal fissure, there is no improvement even after 15 days and the pain in the region becomes chronic.
Causes of Fistula and Anal Fissure
The answer to the question of why fistula and anal fissure occur is often investigated. There are many reasons behind the discomfort, these are as listed below.
- Abscess in the anal region is the most common cause of anal fissure.
- Rectovaginal fistula may occur between the rectum and vagina in women during childbirth due to vaginal tear and infection in the episiotomy incision.
- HIV, tuberculosis, Crohn's disease, hidradenitis suppurativa, chronic inflammatory bowel diseases (ulcerative colitis, etc.), sexually transmitted diseases are also among the causes of fistula and anal fissure.
- It can be transmitted from radiotherapy performed to treat cancer.
- Cancer can cause tissue destruction in fistula formation.
- Small sac-shaped structures in the large intestine (diverticulitis) may occur if infected.
- It may occur as a complication after surgical procedures performed near the anus, such as hemorrhoid surgery.
- It may occur after surgeries on the posterior wall of the vagina.
- Operations such as cesarean section or removal of the uterus usually result in the formation of a fistula between the vagina and the bladder.
What is Fistula and Anal Fissure Surgery?
Anal fistula is the general name of abnormal structures that form between the skin around the anus and the last part of the intestine and look like a small tube. It is mostly caused by an abscess formed as a result of an infection near the anus. After the abscess drains, it leaves a small canal. The skin irritation and discomfort felt by the patient may be advanced. Anal fistula generally does not heal on its own and requires surgical intervention.
It has been observed that fistula occurs in one of every 2-4 people with abscess in the anal region. Although rare, it can be resolved with treatment methods. For this reason, the physician primarily tries to treat it and if it does not get results, he or she resorts to surgery.
How is Fistula and Anal Fissure Surgery Performed?
Fistula and anal fissure surgery is performed with local anesthesia or spinal anesthesia, which numbs the lower part of the waist. The patient does not need to be put under general anesthesia. For the operation, the patient lies prone in the proctological position of the jackknife. While under anesthesia, the breech area is examined by the surgeon and thus the length and depth of the crack are determined precisely. A 1-centimeter incision is made from the side of the anus.
The internal sphincter is the muscular structure that regulates contraction at rest. First of all, this structure is isolated and a loosening cut is performed. Depending on the patient's condition, the surgeon can make adjustments by cutting the sentinal pile (proboscis) formed at the outer end of the anal fissure. During the fistula and anal fissure operation, the crack is not sutured. Instead, the surgeon enters from another point and relaxes the internal sphincter. The main purpose is to solve the problems of poor circulation and spasm in the area where the wound is formed. In this way, the blood flow towards the fissure is increased and some of the muscles that constantly contract in the area are removed.
What are the Advantages of Fistula and Anal Fissure Surgery?
With fistula and anal fissure surgery, the patient's pain is significantly reduced. While going to the toilet was a painful and painful process before, it will be in the benefit of the patient if this situation disappears. In operations performed with closed surgical methods, instead of creating a long incision in the tissue, a very thin hole is opened and thus access to the muscles is provided. Therefore, the risk of gas or fecal incontinence is thus eliminated.
The high success rate makes the operation one of the ideal treatment methods. In addition to the operation performed correctly by a competent specialist in the field, the probability of recurrence of the anal fissure is very low if the patient follows the recommendations given. At the same time, fully fulfilling what the doctor says provides a quality healing process. This means that with a single operation, the patient provides lifelong comfort.
Post Fistula and Anal Fissure Surgery Process
At the end of the operation, the patient is usually discharged or can stay in the hospital for 1 night depending on his condition. After fistula and anal fissure surgery, there may be slight blood leaks in the breech region of the patient, but these usually end within 1 or 2 weeks. In the same way, the wounds close in 1-2 weeks, and the painful process in the patient ends. The success rate of anal fissure surgery is over 95 percent, so it is considered a widely applicable and safe treatment method.
Being careful about cleaning to prevent infection of the anal area after the operation is among the biggest responsibilities of the patient. Creams and medications given by the general surgeon should be used exactly as instructed. For the relief of the patient, it is recommended to take a sitz bath in warm water, a diet rich in fiber and vegetables, and drinking plenty of water. In addition to these, the patient should avoid drinks containing caffeine and alcohol. Contrary to popular belief, it is recommended to defecate regularly after surgery.
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