Fistula in ano
Preparation:
As for general anaesthetic in addition patients may be given a suppository or an enema to clear the lower bowel prior to the procedure.
Procedure:
The first stage of the treatment of any patient with a fistula-in-ano is to determine where the connection between the skin and the anus is. This will usually involve probing the opening and thereafter may require the injection of a marker into the tract. It is important to determine whether the fistula tract involves any of the muscle of the anal sphincter as this will determine subsequent treatment.
The options for treatment are:
- If little or no muscle is involved to cut the fistula tract open
- If a significant part of the sphincter is involved it is likely to require insertion of a seton to establish drainage. Thereafter the seton will be replaced until it is clear that the fistula tract is draining and resolving.
- In cases where there is acute inflammation it may be very difficult to identify the fistula and a further examination may be required.
Anaesthetic:
General or spinal
Post Op:
If the fistula is cut open regular dressings will be required until the wound has healed. It is inevitable that there will be a degree contamination of the wound but they usually heal quickly – indeed supervision of the wound is required to ensure it does not heal over too quickly as this may happen without healing of the deeper layers and lead to a recurrence of the fistula.
OPC Code:
H5510 Low anal Fistula
H5520 High anal fistula
