Anal Fistula surgery: cost, duration and step by step

• Anal fistula surgery aims to eliminate the symptoms caused by the appearance of the fistulous tract and its consequent discomfort.
• Although the discomfort caused by the fistula can be relieved by medication, the only remedy that eliminates the cavity caused by the condition is surgery.
• The duration of the surgical intervention, fistulotomy or fistulectomy, is approximately 30 to 90 minutes, depending on the complexity of each case.

An anal fistula is caused by the blockage of an anal gland, leading to the formation of an abscess which, when it collapses, establishes a path that connects the affected area with the skin surrounding the anus; this connection is called a fistulous tract.

The growth of the fistulous tract in its first stage does not cause pain, but does cause itching and irritation due to the pus that drains out. This abnormality usually forms between two organs, for example between blood vessels, between arteries and veins or in the intestine. The most common location is the area around the anus, forming two orifices, an outflow orifice and an internal orifice (inside the rectum).

Types of Anal Fistula

There are several types of anal fistulas and they are differentiated according to their trajectory:

• Suprasphincteric: these are fistulas that cross above the external sphincter.
• Transsphincteric: these are fistulas that pass through both the internal and external sphincter.
• Extrasphincteric: this type of fistula does not cross the sphincter, but rather the fistulous trajectory goes outside the sphincter.
• Intersphincteric: these are fistulas that cross the internal sphincter.

Causes of Anal Fistula

Anyone is at risk of developing anal fistula, although the condition is more common in men aged 30-50 years. In children, anal fistulas are associated with inflammatory bowel diseases such as Crohn's disease, but as aforementioned, this abnormality is very rare in infants.

As we explained at the beginning of the article, the formation of an anal fistula is mainly the result of an abscess, i.e. inflammation and infection of an anal gland. However, it is sometimes caused by diseases such as sexually transmitted diseases, inflammatory bowel diseases, cancer, tuberculosis, trauma, anal sex or diabetes.

Symptoms caused by anal fistula

Even if you suffer from anal fistula, you may not have any symptoms, especially if the abnormality is in the area furthest away from the anus. However, when the fistula is close to the anus, you may experience a number of uncomfortable signs that tend to worsen over time, including discharge of pus or yellowish fluid, sharp pains in the area, bleeding, itching and stinging around the anus and, in the case of infection, fever.

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The need for surgical treatment is basically to eliminate the symptoms caused by the abnormality, preventing infection and complications that can seriously affect your health.

Although taking certain drugs may alleviate the symptoms (fever, pain or general malaise) for some time, the problem will not be eliminated until surgery is performed. After the operation, the closure of the fistulous tract is ensured, guaranteeing your peace of mind and restoring your quality of life.

As for the treatments that can be used to eliminate an anal fistula, in this section, we explain the procedure for each one and how they differ from each other. The technique used to treat a fistulous tract depends directly on the type of fistula the patient has and the length of time they have been suffering from it. Below we will discuss these treatments and what they consist of:

• Fistulotomy: this surgical procedure consists of opening and emptying the fistulous duct, eliminating the infected tissue. This technique ensures the rapid and correct healing of the tract.
• Fistulectomy: unlike the previous technique, during this surgery the fistula tract is completely removed, after this procedure the wound is larger and has a slower and more complex healing process.
• Sedal or seton: this technique can be performed in three different ways (cutting seton, drainage seton and guide seton), depending on the purpose to be achieved. It consists of passing a fishing line through the fistula duct, draining the liquid present in the trajectory or sectioning the affected sphincter. This technique cleans the area for subsequent surgical repair.

On the day of the surgery, the first step you will have to take is to hand in the necessary documentation at the admissions desk. The healthcare staff will then accompany you to the pre-surgical room, where they will prepare you for surgery by giving you surgical clothes and explaining what will happen during the surgery. After that, you will be taken to the operating theatre and the surgery will begin.

As we mentioned at the beginning of this article, there are several surgical techniques to remove an anal fistula, so you can be operated either by fistulotomy or fistulectomy. The following steps are followed:

Fistulotomy: step by step

In this procedure, the fistulous tract is opened and emptied. The following steps are performed during this procedure:

• First of all, the anaesthetist will apply local anaesthesia so that you will not feel any pain or discomfort during the surgical procedure.
• After the anaesthesia has taken effect, the surgeon will insert a probe that will serve as a guide to cut along the fistula.
• He or she will then use an instrument to scrape any tissue build-up from the fistula. The surgeon will also open and drain any abscesses.
• Next, he or she will close the rectal opening to the fistula. The other opening of the fistula that is in the skin will remain open during surgery using sutures, heat, or other methods.
• In some cases, the specialist may place a thin thread-like material in the wound to help drain the fluid.

Fistulectomy: step by step

This technique consists of the complete removal of the fistulous tract:

• Once inside the operating theatre, the first step is to apply local anaesthesia, numbing the area so that you cannot feel anything during the intervention.
• After the anaesthesia has taken effect, the surgeon will make a cut to access the fistulous tract to be closed. It is also possible to place a ligature across the tract for delayed closure.
• Depending on the complexity of the fistula, the specialist will either repair the affected sphincters, or place skin grafts to plug the hole. If the fistula is complex, i.e. it communicates with other organs, the surgeon will have to repair both orifices, in extreme cases even requiring the implantation of an artificial anus.
• The surgery ends by placing special dressings over the wound to help the wound to heal and heal.

After the surgery, you will be taken to your room to recover from the effects of the anaesthesia, where you will be given the necessary care until you are discharged from hospital.

Before you leave, your doctor will give you a series of instructions on how to care for the wound and prescribe the necessary drugs to soothe any postoperative discomfort.

The surgery lasts around 30-90 minutes, and the patient usually goes home after the surgery, although a 1-day hospital stay is recommended. The pain gradually disappears after the surgery, as the wounds heal.

Full recovery takes between 3 and 6 weeks after surgery, depending on the complexity of each case and the characteristics of the patient.

Everything we have said about the price of anal fissure surgery is based on the way we work at Operarme, specialists in surgery. Our interventions include everything necessary to carry out the surgical treatment of anal fistula repair with the greatest possible safety and effectiveness for the patient, providing an all-inclusive closed price starting from 2.290 €.

What is included in the price of anal fistula surgery?

Below you will find a breakdown of what is included in the price of Anal Fistula surgery at Operarme:

• Booking and use of operating theatre
• Single room with accompanying bed with meals and hospitality for up to 1 day for the patient.
• Stay in post-surgical recovery room, monitoring and necessary treatments
• Preoperative tests (blood tests, electrocardiogram and chest x-ray according to medical indication).
• Post-operative visits until medical discharge
• Medical fees
• Anaesthesiologist fees
• Nursing team fees
• Surgical material necessary for the operation
• Medical complications insurance.

In addition, our company offers the patient a free transfer service for the day of admission and also discharge from hospital, thus avoiding the need to take the car. Similarly, the patient has continuous access to our Patient Service department, with whom he/she can resolve any queries or setbacks.

If you have discomfort caused by an Anal Fistula, and you are thinking of having surgery with us, you can request a surgical assessment consultation with our specialist in general surgery free of charge and immediate. You will be able to meet our specialists in General Surgery, who will familiarise themselves with your case, and you will be able to decide the best option to eliminate once and for all the problems caused by anal fistula.

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