A piece of the wall is taken for examination under the microscope to rule out Crohn’s disease or a tumour. You should be able to have your operation as a day case, which means you come into hospital and go home the same day.
The treatment of a high fistula aims to do the same, but is more complex, because of the anal sphincter and the underlying disease in the bowel. Sometimes it is not possible to tell before surgery the extent of the fistula and decisions are made when you are under anaesthetic.
The discharge and bouts of pain, swelling and bleeding should stop as the fistula heals. If there is Crohn’s disease or a tumour, more treatment will be planned.
Are there any alternatives?
If you do nothing, the fistula may heal up by itself. More often, the discharge continues. Perianal abscesses may form in the same place over time.
With some very complex high fistulas, just treating the abscesses that appear from time to time may be the best treatment.
An older treatment was to pass a thread from the skin opening, through the fistula, out through the anus, and to tie the thread in a loop. The loop would pass through the tissues over several weeks. The fistula heals as the tissues also heal.
Author: Mr Michael Edwards FRCSEng FRCSEd. Consultant general surgeon.
© Dumas Ltd 2006