Rectal Fistulotomy

WHAT YOU SHOULD KNOW:

A rectal fistulotomy is surgery to heal a fistula near your anus. A rectal fistula is a tunnel-like wound that forms next to your anus, often after you have an abscess (pus buildup under your skin). It spreads from inside your rectum to the skin surface near your anus. A rectal fistulotomy opens and drains the rectal fistula. The wound heals by filling in with scar tissue so the fistula does not come back or form an abscess. Your caregiver may also drain an abscess during your surgery.

CARE AGREEMENT:

You have the right to help plan your care. Learn about your health condition and how it may be treated. Discuss treatment options with your caregivers to decide what care you want to receive. You always have the right to refuse treatment.

RISKS:

  • A rectal fistula rarely heals without surgery. Infection from a rectal fistula may be life-threatening without surgery. You may have severe pain after your surgery. You may lose bowel movement or gas control if the sphincter in your anus is cut. A sphincter is a muscle that helps you control when you pass gas or bowel movements.

  • You may get a fever, skin infection, or have bleeding after surgery. It may be painful to pass a bowel movement, or you may be constipated as you recover from surgery. This is more common in elderly patients. Rarely, you may not be able to urinate as easily as before. You may also get a urinary tract infection. This is a bacterial infection that makes it painful to urinate. You may also have swelling or drainage in your wound area. Your rectal fistula may come back, even after surgery. You may need more than one surgery to help heal the fistula. You may have chronic (long-term) drainage. Your healing may be delayed if you have Crohn disease. Rarely, your fistula could cause cancer or sepsis if it is not treated. Sepsis is a dangerous blood infection caused by bacteria that can be life-threatening.

WHILE YOU ARE HERE:

Before surgery:

  • Informed consent is a legal document that explains the tests, treatments, or procedures that you may need. Informed consent means you understand what will be done and can make decisions about what you want. You give your permission when you sign the consent form. You can have someone sign this form for you if you are not able to sign it. You have the right to understand your medical care in words you know. Before you sign the consent form, understand the risks and benefits of what will be done. Make sure all your questions are answered.

  • Your bowel may need to be emptied and cleaned out before the surgery. Caregivers may give you a liquid medicine called an enema. This will be put into your rectum to help empty your bowel.

  • An IV is a small tube placed in your vein that is used to give you medicine or liquids.

  • Your caregiver may need to look inside your rectum with a scope to find your fistula. This scope is a long, bendable tube with a camera on the end. You may be given this exam during surgery, with medicine that helps you fall asleep. This will happen if was too painful during your precare visit.

  • You may also need an ultrasound before your surgery. This is a machine that uses sound waves to take pictures of your rectum and anus. This will help your doctor see inside your rectum.

  • An anesthesiologist will talk to you before your surgery. You may need medicine to keep you asleep or numb an area of your body during surgery. Tell caregivers if you or anyone in your family has had a problem with anesthesia in the past.

  • Regional anesthesia: Medicine is injected to numb the body area where the surgery or procedure will be done. You will remain awake during the surgery or procedure.

  • General anesthesia will keep you asleep and free from pain during surgery. Anesthesia may be given through your IV. You may instead breathe it in through a mask or a tube placed down your throat. The tube may cause you to have a sore throat when you wake up.

During surgery:

  • You will be given anesthesia to make you fall asleep. You will be placed on your stomach or on your back with your feet in stirrups. Your caregiver will tape each side of your buttocks open so he can see your wound. Your caregiver will use his finger to guide a probe into your fistula. He may also need to inject a dye into the fistula to help him find the opening in your rectum. Your caregiver will insert a tool to hold the fistula open. This will help him move the probe through it with ease.

  • Your caregiver will use the probe as a guide to cut along the length of the fistula. Then, your caregiver will use a tool to scrape out any tissue buildup from your fistula. Your caregiver also may need to cut open and drain any abscesses (pus buildup under the skin) during your surgery. The skin around the fistula will be held open with stitches, surgical glue, or heat (cauterization). This allows the fistula to heal from the inside out. Your stitches will dissolve and will not need to be removed.

  • Your caregiver may inject numbing medicine into your wound. This will help ease pain and stop the bleeding when you wake up. He may also place a thread-like material called a seton inside your fistula. Setons allow fluid to drain out of the fistula as your wound heals. Your caregiver may pack your wound inside your rectum with gauze to help absorb any fluid or blood. He may also cover the wound on your anus with a bandage.

After surgery:

You will be taken to a recovery area where caregivers will watch you until you are alert. You may be able to go home if you have enough fluids in your body. You may need to stay in the hospital overnight if you have severe pain or need fluids.

Medicines:

You may be given the following medicines:

  • Pain medicine: Caregivers may give you medicine to take away or decrease your pain.

    • Do not wait until the pain is severe to ask for your medicine. Tell caregivers if your pain does not decrease. The medicine may not work as well at controlling your pain if you wait too long to take it.

    • Pain medicine can make you dizzy or sleepy. Prevent falls by calling a caregiver when you want to get out of bed or if you need help.

  • Stool softeners: This medicine makes it easier for you to have a bowel movement. You may need this medicine to treat or prevent constipation.

  • Antibiotics: This medicine is given to help treat or prevent an infection caused by bacteria.

Vital signs:

Caregivers will check your blood pressure, heart rate, breathing rate, and temperature. They will also ask about your pain. These vital signs give caregivers information about your current health.

Pulse oximeter:

A pulse oximeter is a device that measures the amount of oxygen in your blood. A cord with a clip or sticky strip is placed on your finger, ear, or toe. The other end of the cord is hooked to a machine. Never turn the pulse oximeter or alarm off. An alarm will sound if your oxygen level is low or cannot be read.

Heart monitor:

This is also called an ECG or EKG. Sticky pads placed on your skin record your heart's electrical activity.

You will be able to drink liquids and eat certain foods

once your stomach function returns after surgery. You may be given ice chips at first. Then you will get liquids such as water, broth, juice, and clear soft drinks. If your stomach does not become upset, you may then be given soft foods, such as ice cream and applesauce. Once you can eat soft foods easily, you may slowly begin to eat solid foods.

Sitz bath:

Your caregiver may have you sit in a sitz bath before you go home. A sitz bath is a pan that holds warm water and fits in the toilet bowl. Your caregiver will tell you how often to take a sitz bath. Sitz baths help keep your wound clean and may ease your pain.

© 2014 Truven Health Analytics Inc. Information is for End User's use only and may not be sold, redistributed or otherwise used for commercial purposes. All illustrations and images included in CareNotes® are the copyrighted property of A.D.A.M., Inc. or Truven Health Analytics.

The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.

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