Fistulectomy
| Fistulectomy | |
|---|---|
| ICD-10-PCS | K60.3 |
Fistulectomy is a surgical procedure where a surgeon completely removes a fistula, an abnormal tract (i.e. tube) that connects two hollow spaces of the body.[1][2] In comparison to other procedural options of treating fistulae such as fistulotomies, where a fistula is cut open (i.e. unroofed) but not completely removed, and seton placement, where a rubber band seton is passed through the tract and left post-operation as a means to allow drainage of the fistula, fistulectomies are considered to be a more radical approach.[3][2] The total removal of a fistula may damage nearby structures in the process.[3]
In practice, fistulectomies are primarily performed by colorectal surgeons to treat anorectal fistulous tracts, as fistulas commonly emerge in the anorectal region.[2] In this case, fistulectomies may compromise a patient's anal sphincter, as the removal process may necessitate the surgeon to cut through the muscle. As a result, this may lead to complications such as incontinenece.[3] For this reason, fistulectomies are no longer considered the "gold standard".[3]
Indications
[edit]Based on guidelines published by the American Society of Colon and Rectal Surgery (ASCRS) in 2016, simple and complex anal fistulas were to be treated by fistulotomy or rubber band seton placement with fistulectomies being a secondary option.[4]
Fistulectomy can be considered in non-anorectal fistulas as well. In these circumstances, a fistulectomy may be the best option for the removal of a patient's diseased soft tissue.[5]
Procedure Steps
[edit]For anorectal fistulae, the surgeon begins by identifying the internal and external opening of the fistula. The external opening is usually on the patient's skin and can be identified in clinic.[6] The internal opening is within the anus, and can be found while the surgeon examins the anorectal columns while the patient is under anesthesia. A methalyne blue dye or a peroxide solution may be used to aid with this process.[6]
Once the openings of the tract are found, a thin metal probe is strung through. Using scissors or electrocautery, the surgeon then cores out the tunneling tract.[6] At this point, the surgeon inspects the anal sphincters and closes any defects that were made during the procedure.[6] The wound can then be left open to heal or closed by approximating the tissue back to its anatomic position with sutures.[6]
Possible Complications
[edit]As described above, when a fistulectomy is performed to remove an anorectal fistula tract that involves the anal sphincters, a common complication that may occur is fecal incontinence.[3] The degree of incontinence can be measured using the Wexner score, which can allow surgeons to monitor the progression of incontinence post-operatively.[7]
As with other surgeries, fistulectomies may also pose other complications such as delayed wound healing and infection.[7]
See also
[edit]References
[edit]- ^ "Definition of FISTULA". www.merriam-webster.com. Retrieved 2024-01-15.
- ^ a b c Jimenez, Mercy; Mandava, Nageswara (2023), "Anorectal Fistula", StatPearls, Treasure Island (FL): StatPearls Publishing, PMID 32809492, retrieved 2024-01-12
- ^ a b c d e Seyfried, Steffen; Herold, Alexander (December 2019). "Management of Perianal Fistulas in Crohn's Disease". Visceral Medicine. 35 (6): 338–343. doi:10.1159/000504103. ISSN 2297-4725. PMC 6944889. PMID 31934580.
- ^ Hwang, Sung Hwan (2022). "Trends in Treatment for Hemorrhoids, Fistula, and Anal Fissure: Go Along the Current Trends". Journal of the Anus, Rectum and Colon. 6 (3): 150–158. doi:10.23922/jarc.2022-012. PMC 9328791. PMID 35979269.
- ^ Bocchi, Maria Beatrice; Cianni, Luigi; Perna, Andrea; Raffaele, Vitiello; Greco, Tommaso; Maccauro, Giulio; Perisano, Carlo (2020-12-30). "A rare case of Bacillus megaterium soft tissues infection". Acta Biomedica: Atenei Parmensis. 91 (14–S): e2020013. doi:10.23750/abm.v91i14-S.10849. ISSN 2531-6745. PMC 7944702. PMID 33559642.
- ^ a b c d e "Fistulectomy - an overview | ScienceDirect Topics". www.sciencedirect.com. Retrieved 2024-01-15.
- ^ a b Farag, Ahmed Farag Ahmed; Elbarmelgi, Mohamed Yehia; Mostafa, Mahmoud; Mashhour, Abdrabou N. (2019-08-01). "One stage fistulectomy for high anal fistula with reconstruction of anal sphincter without fecal diversion". Asian Journal of Surgery. 42 (8): 792–796. doi:10.1016/j.asjsur.2018.12.005. ISSN 1015-9584. PMID 30738718.
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