What is a Fistula?
A fistula is the name given to an abnormal connection between two organs or vessels which are not normally connected. Fistulas can develop in a wide range of locations all over the body. For example, a fistula can develop between the stomach and duodenum, or between the rectum and the surface of the skin.
Fistulas can develop for a variety of reasons, depending on the location of the fistula. Rectal and anal fistulas, for example, are most commonly caused by bowel diseases such as ulcerative colitis and Crohn’s disease. Fistulas may develop as a complication of certain types of surgery, or as a result of traumatic physical injury.
Treatments for Fistulas
Fistulas are usually treated with surgery to remove the fistula and repair the damage it has caused. Following surgical treatment the patient is given a course of antibiotics to prevent infection and ensure the area heals properly. In conjunction with surgery to treat fistulas, it is also important that the underlying condition causing the fistula is managed properly to prevent a recurrence.
Fistulotomy and fistulectomy are the two most common surgical treatments for fistulas.
Fistulotomy and Fistulectomy
Surgical treatments for fistulotomy are carried out with the goal of achieving several things: the fistula must be drained to remove pus and other fluid, the fistula tract itself must be opened or removed, and the damage must be repaired to prevent further recurrence of fistulas. Finally, the procedure is carried out with the hope that form and function of the damaged tissue can be restored to normal.
Depending on the location and nature of a specific fistula, either a fistulotomy or a fistulectomy is performed as a surgical treatment.
Generally, a fistulotomy is performed in cases where the fistula is located close to the skin. For example, when an anal fistula is located close to the rectum and anal tract, the fistulotomy is the preferred surgical treatment. This is carried out by opening the anal fistula, draining pus and other fluid, and then merging the fistula tract with the anal canal to allow the fistula to heal.
In cases where the fistula is located deeper within the body, the preferred surgical treatment is a fistulectomy, in which the fistula is removed entirely. This is often the preferred option in cases where a fistula has developed between two organs, for example.
Both procedures are usually carried out under general anesthetic, but side effects and risks vary depending on the type of procedure that has been performed, and the location of the fistula. As a general rule, there are fewer risks and shorter recovery times associated with fistulotomy as compared to fistulectomy.
Andre Hebra, MD. Perianal Abscess: Treatment
Carlos Pastor, MD, PhD, John Hwang, MD, Julio Garcia-Aguilar, MD, PhD. Fistulotomy. Seminars in Colon & Rectal Surgery, Volume 20, Issue 1, pp18-23.
Michael E. Debakey Department of Surgery at Baylor College of Medicine: Fistulotomy