Rectal fistulas are preformed passages between the rectal cavity and the skin through which bacteria in the rectal cavity move with the soft tissue around the rectum, maintaining continuous inflammation, recurrent abscesses and secretions. Rectal polyps can be isolated by their position in relation to the sphincter and their surgical solution adapted accordingly.
In Hippocrates surgery, a thread is introduced into the fistula passage and knotted tightly, followed by repeated knotting every week in an outpatient setting, so that a gradual force on the fistula passage can be used to eliminate it, while sparing the sphincter function.
There is little chance of spontaneous closure of the rectal fistula, so surgical intervention is needed to remove the fistula passage. The reason for this is that a significant part of the rectal fistula runs through the anal sphincter, so simple excision can damage the anal sphincter, leading to permanent bowel dysfunction. Typical symptoms (discharge, recurrent inflammation, abscesses, itching) disappear with fistula removal.
You will most likely arrive on the day of your operation, although it is rare that you will need to be in bed the night before. We will carry out the necessary investigations 1-2 weeks before the planned day of surgery, which may include laboratory tests, ECG, X-ray and anaesthesia if necessary.
The operation is performed under general anaesthesia, with the patient lying on a stretcher. The skin or rectal opening of the fistula passage is explored, probed and threads are inserted into the passage, which are tied and left in place after the operation. The wound is dressed with a bandage. If there are several passages around the rectum, thread is also inserted into them.
In the case of surgical repair of rectal fistulas, the duct can be blocked with various tissue adhesives, stoppers or, after seton drainage, also be obliterated. There are no conservative or drug therapy alternatives. If you have active Crohn’s disease, pre-treatment with medication is recommended.
Postoperative pain in the surgical area, skin and tissue damage, inflammation, scarring, wound infection, numbness around the wound, deep vein thrombosis.
After waking up, you can expect to experience some discomfort, and we will do our best to minimise this, or if it has developed, to alleviate it.
There may be some discomfort in the surgical area, which should also improve considerably with the use of painkillers. Painkillers will gradually become unnecessary over the coming period.
It is important that you take painkillers regularly for the first few days, not just when you are in a lot of pain, so that they have a more even effect.
You can go home the next day after the operation.
After surgery, in addition to the recommended seated bathing, it is recommended to facilitate bowel movements by consuming 3×1 tablespoon of Paraffin oil daily.
After the surgery, a weekly knotting of the threads is required and is performed in our outpatient clinic.
When can I take a bath or shower?
A clean covering dressing will be applied to the wound and changed daily. The day after surgery, the wound may be exposed to water, and you will need to shower the wound after bowel movements. After showering, the wound should be dressed with a covering dressing.
Exercise:
You will feel more fatigued in the few weeks after surgery, a gradual return to daily activity is recommended. For the first 2-3 weeks, avoid heavy physical work, lifting weights and intense sports activities.
Work:
Return to work depends on the type of work and the extent of the surgery. Expect to return to work within 1-2 weeks.
