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 fistulas can be differentiated by their position in relation to the sphincter and their surgical solution adapted accordingly. Seton drainage is used when the duct cannot be eliminated in one session because of its proximity to the sphincter and its passage through it, or when, because of branching ducts, the body is forced to block the peripheral ducts and form a main fistula which can be eliminated in a second step.
There is little chance of spontaneous closure of the rectal fistula, so surgical intervention is required to remove the fistula. A significant proportion of the rectal fistulae pass through the anal sphincter, so simple excision can damage the anal sphincter, leading to permanent bowel dysfunction. Following surgery, the body reacts by forming scar tissue around the inserted rubber band, and the branching or lateral passages close, in preparation for the second stage of fistula tube eradication.
The second step of the treatment, definitive eradication of the duct, is the elimination of the symptoms (recurrent abscess formation, discharge, inflammation) resulting from the rectal fistula.
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 footrest. The skin and rectal orifices of the fistula are explored and probed, and rubber strips (seton drains) are placed in the orifice and left in place after the operation. The wound is dressed with a dressing. If there are several passages around the rectum, they are also treated with seton drains.
In the case of surgical repair of rectal fistulas, the duct can be blocked with various tissue adhesives, plugs and Hippocratic knots. 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 around the inserted drain, which should also improve considerably with the use of painkillers.
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 surgery, the seton drain should remain in place for at least 3 months to allow the fistula passage to strengthen around the rubber drain, after which the drain is removed and the fistula is eliminated in a second surgical session.
When can I take a bath or shower?
A clean covering dressing will be placed over 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.
