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Fistula was detected through X-Ray. Advise to take second operation to whether it is fistula. What to do?

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Practicing since : 1978
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Patient's Name: Mr. XXXXXXX XXXX

Age: 35 Years (M)

Problem: Fistula in Ano

Fistulas Track detected on 26.06.2013 (report attached)

Operation performed : 03.07.2013

Problem after Operation: Still Discharge and pain in Ano region.

The fistula was detected through X-Ray on 26th XXXXXXX 2013, The operation for the same was performed on 3rd July 2013. As the pain in affected region discharge was still there so he opted for MRI.
After MRI (Report attached) it has been told by doctor that there is fistula, which needs to be operated again. The doctor was confused about either it is fistula or a track which has been created after the removal of fistula. He said that he will give anesthesia and then he will check either there is fistula (or dead cells) or not, if it is, then he will remove the same. After this second operation, he will cure in next 2 to 3 months, and in case if he does not opt for this operation, the discharge and pain problem will not be cured even if he takes medicines for 2-3 years. We are so much confused either 2nd operation will cure it and what is the scope that it will not redevelop for the third time. The doctor who operated says that there is pus inside and he will remove the same and then it will be cured. He has already taken antibiotics for 2-3 months. Should we go for operation, can it be cured without the same. What are the chances that it will not spread further. The Doctor who has performed operation has given us another date of 17th October 2013. At this time there is a pressure in mind to think about 2nd operation, because pain is still there. Please suggest.
Posted Fri, 1 Nov 2013 in Constipation
Answered by Dr. Pavan Kumar Gupta 2 hours later
Brief is very common for recurrence of anal fistula.
Detailed answer...
I can understand the problem being faced by the patient.
There is always a risk of recurrence of anal fistula after the fistula surgery.
Inspite of the advancement of medical science over past years,the cornerstone of treatment of anal fistula is surgery only.
Even now,there is no other option for you except to go for surgery again.
The role of antibiotics is just to take care of associated infection only.
You must consult a specialised surgeon called as colo rectal surgeon.These surgeons have special skill in operating anal fistulas.The patient would require detailed investigations prior to the next surgery,so as the exact extent of fistula tract beforehand.
A surgery by the skilful surgeon is the most important requirement.
Don't hesitate for the repeat surgery,because that is the only option for you.
I hope it helps,however you may revert to me for any further query.
Best of luck.
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