Anal Fistula Surgery Risks: Traditional Surgery vs Laser Procedure
You can't wish away an anal fistula, nor can you treat it with antibiotics. The only thing to do is to undergo surgical treatment designed to repair your anorectal tissue. The goal is to remove or close the fistula channel and keep it away for good.
Of course, there are anal fistula surgery risks that must be weighed before the procedure. For long-term satisfaction with your treatment, you should consider all treatment options and select the one that offers a low risk of serious complications and a high chance of success.
Risks Associated with Fistulotomy Surgery
Surgical procedures are the traditional treatment methods for anal fistulae. Fistulotomy is usually the surgical method that doctors choose.
This process involves laying open the fistula channel by cutting along the length of it. Diseased tissue is cleaned out, but the tract itself is not removed. The wound is stitched in a manner that keeps the tract open.
Because this method takes off the tissue that was above the tract and leaves the channel exposed, it is sometimes referred to as an "unroofing" procedure. You can view the cutting portion of this surgery in the video below:
Fistulotomy can be a successful procedure with long-term results. However, it is not without risks, especially if the fistula tract is in a tricky position.
Incontinence
The biggest concern with fistula surgery is that the patient will struggle with some form of incontinence afterward. This is because fistula tracts often pass through the anal sphincter.
The sphincter system is a set of two muscles that control the passage of waste materials and gas from the rectum. If the muscles are damaged, a person may not be able to exert proper control.
Fistula tracts, especially when the fistulae are in high positions, may pass right through the sphincter muscles. Performing a fistulotomy can require cutting into these muscles, and there's a good chance that they will no longer work properly afterward.
Stool Incontinence
After the sphincter muscle is damaged, patients may no longer be able to hold in their solid waste. This condition is known as fecal incontinence. It may range from mild underwear staining to complete loss of stool control.
In a study from the Academic Medical Center at the University of Amsterdam, 109 patients who had low fistulae underwent fistulotomy treatments. Afterward, 40 percent of them experienced problems with soiling themselves.
Not all studies show such high fecal incontinence rates. Research out of Kaiser Permanente Los Angeles Medical Center, for example, demonstrated a 10.6 percent chance of patients' losing the ability to hold stool after a fistulotomy.
Gas Incontinence
Part of the sphincter system involves an involuntary muscle that is responsible for keeping gas and liquid from passing out of the rectum. If this sphincter muscle is damaged during a fistulotomy, a person may no longer be able to control the passage of gas.
In addition to collecting data on stool incontinence, the Kaiser Permanent study also evaluated gas incontinence. 5.0 percent of the patients in the study experienced problems with controlling intestinal gas after undergoing a fistulotomy.
Infection
With any surgical procedure, there is a risk of infection. Fistulotomies involve an open wound that is in close proximity to fecal matter. Although this is not usually a cause of infection in a fistulotomy wound, it does serve as a good reminder that proper wound care and cleaning is essential.
Specific statistics on infection rates after fistulotomy are hard to come by. However, researchers have noted that taking antibiotics before or after surgery is not an effective preventive measure.
One study out of the University of Illinois at Chicago noted a 3.7 percent post-fistulotomy infection rate. However, this statistic included only those infections that caused a fistula recurrence that led to a repeat surgery. Other patients may have experienced more mild infections that required less invasive treatment.
Recurrence
There's always a chance that an anal fistula will recur. However, one reason that fistulotomy is a common procedure is that its recurrence rate is low, especially in comparison to some other techniques, such as rectal flaps or glue plugs.
In the University of Amsterdam study, the recurrence rate for those patients who underwent fistulotomy was 7 percent. The other group in the study received rectal advancement flap treatments; among that group, 21 percent of patients experienced a recurrence.
Recurrence happened to 15.6 percent of the fistulotomy patients in the Kaiser Permanente study.
Reasons to Consider Laser Treatment Instead
Some doctors are now using laser probes to close fistula tracts instead of cutting open the channels. With this type of procedure, a special laser is drawn through the length of the tract. As it goes, it ablates the tissue, which seals the passage shut.
Laser treatment is a promising alternative to fistulotomy because it reduces the chances of experiencing major complications, particularly incontinence.
Incontinence
Laser fistula treatment is able to spare the sphincter muscle. Therefore, the chance of post-procedure incontinence is much lower than it is for fistulotomy.
In a study out of Hospital Santo Spirito in Italy, none of the 35 patients who underwent laser ablation for their fistulae experienced incontinence as a result.
In another study of laser procedures, this one from St. Elisabeth Krankenhaus Köln-Hohenlind in Germany, only one of the 11 patients developed incontinence, and that patient's problems were considered mild.
Infection
As with fistulotomy procedures, post-procedure infection rates for laser treatments seem to be low. Neither the Italian study nor the German one reported any instances of infection in the ablation patients who were studied.
Recurrence
Among sphincter-sparing fistula surgeries, laser treatments have one of the lower recurrence rates. For example, a study out of St. Paul's Hospital in British Columbia, Canada found that fistula plugs were successful for 59.3 percent of patients, and fibrin glue healed fistulae in only 39.1 percent of patients.
Contrast this with laser ablation. The Italian study of laser treatments showed a 71.4 percent success rate. In the German study, the success rate was 81.8 percent. In either case, the procedure was more successful than other fistula treatments designed to spare the sphincter muscles.
Anal fistula surgery risks can be scary, but if you don't receive surgical treatment, your condition will never improve. To reduce your chance of experiencing serious complications, consider a laser procedure, which spares the anal sphincter and offers promising results.
As with all medical issues, your physician is the ultimate source as to what procedure best fits your needs. Discuss all options and get a second opinion if you have any doubts. These articles are intended to be a source of general information only.
