What Causes Pain At The Incision Site After A Partial Fistulotomy?

Posted on Thu, 16 Feb 2017

Question: I had a partial fistulotomy with seton done in XXXXXXX 2016 for fistula in ano. 12 weeks later in Sept. 2016 seton was removed and endorectal advancement flap surgery was done. January 1, 2017 I felt pain in the same area, and the pain got worse, so did the swelling. My colorectal surgeon lanced it and some puss came out but not a lot (about a teaspoon he said). Soon after, the swelling went down and so did the drainage, but I could feel a small "cord" had formed like it had with my previous fistula. At my follow up appointment one week after being lanced, the surgeon could feel the cord and said the fistula was returning and scheduled me for surgery to perform the LIFT procedure. Since then I noticed the cord getting smaller, so at my appointment today I told him of that. He inserted a fistula probe through the outside and said that he was getting a lot of resistance and couldn't get the probe through to the anus. So that is an indicator that my fistula is healing itself. He wants me to come in in 3 weeks (feb 13), which is 5 days before my surgery and check again to see if its closed more. If it hasn't then my surgery is still on, if it has then we will cancel surgery. But with my history, the fistulas always seem to go away once lanced and drained, then come back several months later. I fear that my surgery will be cancelled, only for it to form and abscess again in a few months. Doctor said 75% chance I still need surgery. How common is it for fistulas to heal on their own, especially fistulas that return after endorectal advancement flap procedure?

Answered by Dr. Hari Charan Perigela (5 hours later)

Brief Answer:
It looks like an Abscess.

Detailed Answer:
Hi
As per your description, it looks like an Abscess.As the pus is drained,it will be healed.
Fistula is tract with two openings.As the probe is not passing completely,we cannot put it as Recurrent fistula.
I have seen many cases of infection in the fistula area after surgery which responded by incision followed by Antibiotics.
Success rate of Flap repair and LIFT procedure is around 70%.
The area will be thicker after surgery due to fibrous tissue.Do not worry about it.
Even after LIFT procedure, you can feel thickened area.It is not a complication,but tissue reaction.
If the infection has come down and there is no opening, there is no need for another surgery.
No one can predict the timing of infection after surgery.
Hope I answered your query.
Wish you good health
Regards

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Above answer was peer-reviewed by : Dr. Remy Koshy