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Dr. Andrew Rynne
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Dr. Andrew Rynne

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How long is the recovery time after a partial fistulotomy?

Answered by
Dr.
Dr. T Chandrakant

General Surgeon

Practicing since :1984

Answered : 17883 Questions

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Posted on Tue, 24 Jan 2017 in Liver and Gall Bladder
Question: I got a partial fistulotomy with seton in XXXXXXX 2016. In September 2016 we finished the procedure by doing an endorectal advancement flap and removed the seton. I went to to see my colorectal surgeon every two weeks until the end of November in which he examined the inside of my rectum via digital rectal exam and an anoscopy. He also examined the out area where the scar was forming to check for evidence of tunneling. All appointments everything looked great. My last exam he said it healed great and would not come back it this point. Today my scar is hurting a little when I touch it. I don't feel any hard spots where infected fluids would be inside like I did prior to my surgery. The area doesn't look red or infected, but the scar is all of the sudden painful. I called the surgeon and he said if it's still painful tomorrow it may be a low grade infection so he'll order me antibiotics and to make an appointment with him so he can examine to see if the surgery failed and the fistula opened back up. 1.Is it common to have the fistula reopen 3 months after two fistula surgeries (my risk of incontinence was high)?
2. What surgeries do they resort to next and what are the success rates? Is it multiple surgeries?
3. Does an infection mean the fistula is back? If not, why would it be infected again?
4. Could it just be painful scar tissue?
doctor
Answered by Dr. T Chandrakant 4 hours later
Brief Answer:
as explained in details.

Detailed Answer:
Hi.
Thanks for your query.
Noted the history of Female/34 - partial fistulotomy with seton - XXXXXXX 2016 - endorectal advancement flap and seton removal - regular followups - healed great in last examination - today - scar tenderness - no hard spot where infected flid would be inside - does not look red or infected - but all of a sudden got painful - called the Surgeon - said about chances of low grade infection will order antibiotic - will see if surgery failed - your queries :
1. Is it common to have the fistula reopen 3 months after two fistula surgeries (my risk of incontinence was high)?
> Not at all common. Once the healing is proper and complete the reopening is not common as the healing is from within. There is no chance of reopening of the fibrous tissues as it is tough. If at all this occurs, it is rare.
Risk of incontinence was high means this was high-anal fistula.

2. What surgeries do they resort to next and what are the success rates? Is it multiple surgeries?
> Once needs to confirm the cause and effects - meaning the extent of the problem first as the extent of the problem can alone decide what type of management.

3. Does an infection mean the fistula is back? If not, why would it be infected again?
> Infection may not mean that the fistula is back in all cases. Anal canal has many crypts which can get infected. There can be scar tenderness as it is situated at the high pressure zone during bowel movement an is subjected to wear and tear during any movement/ shearing action of buttocks and anal area/scan area while walking, standing up, coughing, sneezing. Such actions can
cause tenderness in the scar and is very well known to occur. As also can be nerve entrapment in the scar causing pain and tenderness.

4. Could it just be painful scar tissue?
> Yes, this is what I just tried to explain. Reopening after 3 months of healing is usually not seen.
The cause can be best studies by the clinical examination that your Surgeon will do and assisted by the MRI of the affected area as it can tell us what exactly is going on inside as the per-rectal digital examination can feel only.

I hope this answers your queries and guides you for an early and proper diagnosis.
Please feel free to ask for further relevant queries if you feel that there is a gap of communication.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. T Chandrakant 35 minutes later
But I had endorectal flap, doesn't this have a high risk of failure? You think it is scar pain?
doctor
Answered by Dr. T Chandrakant 4 minutes later
Brief Answer:
As detailed.

Detailed Answer:
Difficult to say for sure without actually examining and having MRI.
The statistics should be known but does not help on individual basis.
Since this is close- cavity area, differentiation is difficult.
Go for examination by your Surgeon and discuss about MRI.
Above answer was peer-reviewed by : Dr. Remy Koshy
doctor
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Follow up: Dr. T Chandrakant 15 hours later
Now there are little hard balls along the scar, in one spot in particular there is a larger ball that has formed. I can't get in to see the surgeon for another 9 days.
doctor
Answered by Dr. T Chandrakant 4 hours later
Brief Answer:
Attach the photos - Meet the Surgeon to get the proper directions

Detailed Answer:
Noted the finding about little hard balls along the scar, larger one at a particular spot and can not see the Surgeon for another days...
This can be due to hypertrophy of the scar.

Can you send the clear and focused photographs of the affected area with someone's help as the photos sometimes help for on-the-spot diagnosis.

You can see your PCP or a Family Doctor to have some evaluation or someone at the office of the operating Surgeon and get started with proper treatment as needed.


Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. T Chandrakant 18 minutes later
How do I upload pictures on here?

Thank you

Also, they aren't visible, they are underneath the scar
doctor
Answered by Dr. T Chandrakant 11 minutes later
Brief Answer:
As detailed below.

Detailed Answer:
Please find the link attached to this query for attachment of the pictures.
And you can also send by email to
YYYY@YYYY

If not visible but are palpable can be indicative of changes of hypertrophy of the scar, a part of healing process of scar. The scar itself usually does not get infected.


Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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