The procedure typically stops the persistent discharge, odour, and irritation that interfere with daily activities.
Fistulotomy Singapore
A fistulotomy is a surgical procedure designed to treat anal fistulas, which are small tunnels that develop between the inside of the anal canal and the skin around the bottom. These tunnels often result from infections in small glands near the anus. The procedure involves opening and draining the fistula tract to allow proper healing from the inside out, removing the infected tissue that prevents natural recovery.
Indications for Fistulotomy
Colorectal surgeons may recommend a fistulotomy for the following conditions:
- Simple anal fistulas: Low-lying fistulas that pass through a small portion of the anal sphincter muscle, typically causing recurring discharge and discomfort.
- Persistent fistula symptoms: Ongoing drainage, pain, or swelling around the anal area that has continued for several weeks despite antibiotic treatment or other conservative measures.
- Failed previous drainage procedures: Situations where initial drainage of an anal abscess has not prevented the formation of a permanent fistula tract.
- Superficial fistula tracts: Fistulas that run close to the skin surface and do not involve significant amounts of sphincter muscle.
Benefits of Fistulotomy
Fistulotomy offers several advantages:
Elimination of troublesome symptoms
Prevention of recurring problems
By removing the infected tract, fistulotomy reduces the likelihood of repeated abscesses forming in the same area.
Single-procedure solution
A simple fistulotomy usually resolves the issue in one surgery, eliminating the need for multiple treatments.
Fistulotomy Surgical Techniques in Singapore
The specific approach to your fistulotomy will depend on the location and characteristics of your particular fistula tract.
Lay-open technique
The surgeon opens the entire fistula tract by cutting through the overlying tissue and muscle, allowing the wound to heal from the bottom upwards.
Probe-guided fistulotomy
A thin probe is passed through the fistula tract to guide the careful division of tissue, ensuring complete opening of the tunnel.
Primary fistulotomy
This approach is used when the fistula is straightforward and involves minimal sphincter muscle, allowing for immediate complete division.
Preparing for Fistulotomy
Proper preparation helps ensure the best possible outcome and reduces the risk of complications.
- Medical evaluation: Your surgeon will review your medical history, medications and may arrange blood tests or other investigations to confirm you are ready for surgery.
- Pre-operative instructions: You will receive specific guidance about eating, drinking, and bowel preparation, typically including when to stop eating and drinking before surgery.
Step-by-Step Procedure
The fistulotomy procedure follows a systematic approach to ensure thorough treatment of the fistula tract.
Anaesthesia administration
You will receive either general anaesthesia or spinal anaesthesia, depending on your specific situation and the surgeon’s recommendation.
Probing and tract identification
A thin probe is gently passed through the fistula opening to map the exact path of the tunnel and identify where it connects internally.
Surgical division
The surgeon carefully cuts through the tissue overlying the fistula tract, creating an open channel that allows the infected tunnel to heal properly from the inside out.
Wound inspection and preparation
The opened tract is cleaned and inspected to ensure all infected tissue has been removed and the wound is ready for healing.
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Post-Surgical Care and Recovery
Immediate Care
- Pain management: Appropriate pain relief medication will be prescribed to manage discomfort.
- Wound dressing: A simple dressing will be applied to the surgical site, which you may need to change as directed by your surgical team.
- Initial mobility: You will be encouraged to move around gently as soon as you feel comfortable, typically within a few hours of the procedure.
Recovery Timeline
- First few days: Some bleeding and discharge from the wound is normal, and you may experience moderate discomfort when sitting or having bowel movements.
- First two weeks: The wound will gradually begin to heal from the bottom upwards, and you should start to notice reduced discharge and improved comfort.
- Complete healing: Full healing typically takes 4-6 weeks, during which time you will need to maintain careful hygiene and follow your surgeon’s aftercare instructions.
Follow-up Care
- Wound monitoring: You will be given guidance on how to observe the healing process and recognise signs that might require medical attention.
- Hygiene instructions: Regular bathing and gentle cleaning of the area will be important throughout the healing period.
- Return to normal activities: Most patients can return to desk work within a few days, though heavy lifting and strenuous exercise should be avoided initially.
Potential Risks and Complications
As with any surgical procedure, fistulotomy has certain considerations your surgeon will discuss with you beforehand. While temporary changes in bowel control, particularly with gas or liquid stools, may occur, these generally improve as healing progresses. The possibility of incomplete healing, infection, or recurrence of the fistula is significantly reduced when the procedure is performed by a qualified colorectal surgeon in Singapore.
Frequently Asked Questions
Will I need time off work after the fistulotomy procedure in Singapore?
Most patients require 3-7 days off work, depending on their job requirements. Those with desk jobs often return sooner than those whose work involves heavy lifting or prolonged standing.
Do I need someone to drive me home after the procedure?
Yes, you will need someone to drive you home as you cannot drive for at least 24 hours after general anaesthesia.
How do I keep the wound clean during healing?
Gentle daily baths or showers are recommended, allowing clean water to run over the area. Pat the area dry with a clean towel rather than rubbing, and avoid using harsh soaps or antiseptics unless specifically advised.
How long will I need to use special wound dressings?
Simple gauze dressings are usually needed for the first 1-2 weeks, and your surgeon will advise when you can stop using them based on your healing progress.
What should I do if I notice increased bleeding or signs of infection?
Contact your surgical team immediately if you experience heavy bleeding, increasing pain, fever, or signs of infection such as increased redness or pus from the wound site.
Will the fistula come back after this surgery?
Recurrence rates for simple fistulas treated with fistulotomy are low, typically less than 5%, though this depends on factors such as the complexity of your original fistula and overall health.
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Our Clinic Locations
Ark Surgical Practice – Mount Elizabeth Medical Centre
3 Mount Elizabeth, #09-07
Singapore 228510
Monday to Friday: 9am – 5pm
Saturday: 9am – 12:30pm
Sunday & Public Holidays: Closed
Ark Surgical Practice – Mount Alvernia Hospital
820 Thomson Road,
Mount Alvernia Hospital, #06-52,
Medical Centre D, Singapore 574623
Wednesday: 9am – 12:30pm
Thursday: 2pm – 5pm