Fistulectomy – Dr. Riti Shah

Following basic investigations:

Anesthesia: Local with sedation or regional anesthesia

Position: Prone i.e. patient lying on the stomach or lithotomy

Procedure: The external opening is identified, methylene blue dye along with hydrogen peroxide is instilled through the external opening and dye is seen coming out through the internal opening. The incision is taken around the external opening and the tract is excised along with the internal opening. The tract is sent for histopathology. After wash, the mucosa is hitched to the skin edge by marsupilization or the wound is closed based on the quality of the tissues of the wound. The anal canal is packed which is removed day after or when patient passes stool.

Post op: Patient is given antibiotics, pain killers, stool softeners and local ointment for management of the wound. A specific dressing is taught which has to be followed. Also patients are given instruction regarding food habits and if sitz bath is needed. Patients will experience pain for the first 2 to 3 days while passing motion which is relieved by medications. Patients can start work on the 3^rd day and can have a routine lifestyle by 3^rd or 4^th week.

Follow up: Patient is followed up on 3^rd or 4^th day and then weekly till wound heals.

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