General Surgery

Fistula (Anus) – High
The complete tract, from the external opening to the internal opening is laid open. Tissue around the external opening and the internal opening is excised along with a small margin of tissue lining the tract (fistulotomy) and the wound kept open for healing by secondary intention. Since the lay-open technique is the standard surgical operation performed it is described in some detail. The position used for surgery varies according to the preference of the surgeon. Many low anal fistula surgery can be performed under local anaesthesia and requires good exposure. The three common positions used for surgery are- lithotomy position, prone (jack-knife) position and left lateral position. The position is not conducive when performing surgery under local anaesthesia since the patient often complains of pain in the thigh and can become uncooperative.

The prone position is often used when doing the operation under local anaesthesia. However patients who have emphysema, bronchospasm, obesity or those who have had coronary artery by-pass surgery through a median sternotomy do not tolerate the prone position well. The left lateral position is eminently suitable position for patients who cannot be put in the prone position. Retraction of the buttocks in any position by means of adhesive needs meticulous attention since strong traction tends to distort the tract and can mislead the surgeon.

Post-operative care consists of twice daily dressing after warm hip bath. Strong antiseptic solutions to cleanse the wound is avoided since allergic reaction to antiseptic solutions is not uncommon. Hydrogen peroxide (20 volumes per cent) diluted with an equal quantity of normal saline (0.9 per cent) is eminently suitable for cleansing the wound following which a dressing of Eusol (sodium hypochlorite) is used. Total healing time depends upon the extent of the wound but is generally between 10-20 days. Time off work is between 4-5 days and normal activity is resumed within three weeks. Stay in hospital is between 1-3 days in most instances. In some cases fistulas can even be treated on a day care basis.