There are many types of fistula, most of which are surgically removable. Types of fistula surgery and recovery times vary, but surgical success rates are high, and most people recover fully.
Fistulas are a fairly common but severe complication of conditions, such as Crohn’s disease and some surgeries.
They can have significant effects on a person’s health and well-being. Some fistulas are treatable with antibiotics and other medications. If these options do not work, surgically removing them may be necessary.
This article explores what to expect from fistula surgery and recovery.
A fistula is an atypical tube-like connection that forms between two organs or vessels inside the body.
They usually occur due to infection or inflammation due to injury or surgery. They can develop in many parts of the body, but the most common types of fistula are:
Anal or perianal fistulas, which form between:
- the anal canal and anal opening
- the rectum or anus and vagina
- the colon and vagina
Urinary tract fistulas, which form between:
- the bladder and uterus
- the bladder and vagina
- the urethra and vagina
- the bladder and colon
Gastrointestinal fistulas, which form between:
- two parts of the intestine
- part of the gastrointestinal tract and the skin
- part of the intestine and another organ in the body, such as the bladder
People can usually manage their fistulas with elective outpatient surgeries. An exception is aortoenteric fistulas, which require immediate attention through emergency surgeries.
Fistulas usually form following some kind of injury or inflammation inside the body.
Inflammation causes ulcers to form. These ulcers may expand to reach another surface inside the body. This creates a channel that helps drain pus from an area with an infection.
Common causes of fistulas include:
- Crohn’s disease
- diverticulitis
- ulcerative colitis
- hidradenitis suppurativa
- tuberculosis
- HIV
- surgery
- childbirth or obstructed labor
- a history of radiation to the abdomen
- physical injury
Some fistulas may heal with the help of antibiotics and other medications, but most require surgery.
The main options for surgical treatment of an anal fistula are fistulotomy and seton surgery.
Fistulotomy refers to when a surgeon cuts a fistula along its whole length so that it heals into a flat scar. It is the most common and effective type of treatment for many anal fistulas.
Seton surgery involves placing a piece of thin surgical thread inside the fistula to help drain any infection and allow it to heal.
Other treatment options include:
- endoscopic ablation
- a ligation of the intersphincteric fistula tract procedure
- advancement flap procedure
- an
anal fistula plug to close the fistula and allow it to heal medical glue to close the fistula
Treatment for a urinary tract fistula such as colovesical fistula — a fistula between the bladder and colon — usually starts with conservative measures such as antibiotics and dietary changes. If these are not helpful, a person may need surgery to avoid further complications.
A surgeon can remove the fistula and repair the damage between organs to stop the exchange of fluids.
The standard surgical treatment for a colovesical fistula involves:
- removal of the fistula
- closure of the bladder wall
- colic resection with or without temporary colostomy, in some cases
Treatment for a gastrointestinal fistula depends on its severity and location. Small fistulas without an infection will often close on their own and may take 30–50 days. However, more severe fistulas that drain may cause infection in the surrounding skin and organs. If the drainage leads to sepsis, a doctor will usually recommend surgery to repair the areas of drainage.
All procedures for treating fistulas have different benefits and risks. A person should discuss these with their surgical team so they can be sure of what to expect during surgery.
The type of surgery will differ depending on where the fistulas are. Here is what to expect in three different kinds of fistula surgeries:
Fistulotomy
Surgery for an anal fistula usually takes 15–30 minutes, but a person will need to spend some time in the hospital before and after to prepare and recover.
If the fistula is small and shallow, a person may only need a local anesthetic during the procedure. Otherwise, a surgeon will put them to sleep using a general anesthetic.
During the fistulotomy, the surgeon will make an incision to open up the fistula.
Seton placement
For an anal fistula, this procedure usually takes around 30 minutes, but it can vary depending on how complex the fistula is. A person will be asleep throughout the procedure.
After the surgeon has placed the seton in the fistula, they will cover it with a light, padded dressing.
As long as the surgery has been straightforward and without complications, a person can usually go home the same day.
Surgical teams often perform seton placement surgery in stages, so a person may require further operations to adjust or replace the seton.
Following the surgery, the fistula might continue to drain for several weeks.
Colovesical fistula surgery
This type of fistula most commonly occurs between the bladder and sigmoid colon — the last part of the colon. The procedure to treat this condition involves a sigmoid colectomy, which is the removal of all or some of the sigmoid colon. After this, a surgeon will remove the fistula and patch up the bladder and colon.
This surgery can take the form of an open surgery, which involves a single large incision, or a laparoscopy, which involves a series of small incisions. The average hospital stay after the surgery is 8 days.
The time it takes to recover from a fistula surgery depends on the type of procedure a person underwent and how complex it was.
A person’s surgical team can give tailored advice about how best to recover.
Most wounds should heal within 6 weeks.
General advice about home care after undergoing a fistula surgery includes:
- Take over-the counter pain relievers, such as paracetamol or ibuprofen.
- Follow the medical team’s advice and continue taking antibiotics if symptoms persist.
- Keep the wound clean by washing it several times per day. Dry it carefully by patting it, not rubbing it.
- Change the wound dressing regularly. A nurse should demonstrate how to do this.
- Use an extra gauze pad over the wound to prevent discharge from leaking onto clothes.
- Avoid sexual intercourse for the first few weeks after surgery.
- Exercise gently to avoid irritating an unhealed wound.
- Refrain from heavy lifting or driving.
- Follow a temporary liquid diet if necessary.
- Seek support from people who have been through similar treatment.
With any surgery, there is a risk of complications.
Common complications from fistula surgery include infection, bleeding, and adverse reactions to the anesthetic.
Specific complications of anal fistula surgery include:
- a person losing control of their bowel
- taking a long time for the wound to heal
- the fistula coming back
- narrowing of the anal canal, making it difficult to have a bowel movement
If a person experiences severe pain or difficulty with their bowel movements, they should contact a doctor.
Following fistula treatment, a person may experience the following side effects:
- cramping
- nausea
- constipation
- diarrhea
- soreness around the site of the wound
These side effects should wear off after a few days once the body begins to heal.
Living with a fistula can have sizeable effects on a person’s quality of life.
However, for most people, fistula surgery is effective, and
With so many surgical treatment options, a fistula is rarely permanent. However, diagnosing, treating, and recovering from a fistula can be slow and frustrating. However, support is available for anyone going through this experience.
A person with a fistula can speak with a doctor or healthcare team about the best course of treatment.