A fistulectomy is a specialized surgical procedure that involves completely removing an abnormal tunnel (fistula tract) that has formed between two surfaces or organs. At our practice, we understand that dealing with a fistula can be both physically uncomfortable and emotionally distressing. That's why we're committed to providing compassionate, expert care while helping you understand each step of your treatment.
This targeted procedure effectively treats fistulas that commonly occur around the anal area (anorectal fistulas), though similar techniques are used for fistulas in other body regions. Our fistulectomy approach utilizes advanced surgical techniques to identify and completely remove the entire fistula tract while preserving sphincter function and surrounding healthy tissue. We employ careful mapping of the fistula's path, specialized instruments for precise excision, and strategic reconstruction methods that promote complete healing while minimizing recurrence risk. Our comprehensive approach includes both surgical expertise and detailed post-operative care, resulting in effective, lasting elimination of the fistula while maximizing your comfort and functional outcomes.
You may need a fistulectomy if you experience:
Persistent drainage or discharge from an opening near the anus
Recurrent abscesses in the perianal area
Pain or discomfort in the anal region, especially during bowel movements
Swelling, redness, or tenderness around the anus
Itching or irritation in the perianal skin
Bleeding from an external opening near the anus
Failed previous treatments for anorectal fistula
Visible external opening with periodic drainage
Discomfort during sitting or physical activities
Perianal infection that recurs despite antibiotic treatment
Fistula confirmed by imaging studies (MRI, endoanal ultrasound)
Perianal Crohn's disease with fistula formation
Fistula development following anorectal abscess drainage
Fistula causing hygiene difficulties or soiling of undergarments
Pain or swelling that cycles between improvement and worsening
Our approach to fistulectomy combines precision with individualized care. The procedure begins with comprehensive evaluation, often including specialized imaging such as endoanal ultrasound or MRI to fully map the fistula's path and identify its internal opening and any secondary branches. What sets us apart is our expertise in selecting the most appropriate surgical technique based on your specific fistula type, location, and complexity, while prioritizing preservation of sphincter function and continence.
For straightforward fistulas (intersphincteric or low transsphincteric), we perform traditional fistulectomy, which involves complete excision of the entire fistula tract from the internal to external opening. This approach offers excellent healing rates and low recurrence by removing all infected tissue, though healing time is longer than some other techniques. For complex or high fistulas that involve significant sphincter muscle, we may employ modified approaches such as staged fistulectomy, mucosal advancement flap technique, or LIFT procedure (ligation of intersphincteric fistula tract) to maximize sphincter preservation while effectively treating the fistula.
Our distinctive approach includes meticulous identification of the internal opening—a critical step in preventing recurrence—and the use of advanced surgical tools that allow precise tissue removal while minimizing damage to surrounding structures. For patients with Crohn's disease or other complicating factors, we coordinate closely with gastroenterologists to optimize medical management alongside surgical intervention. Throughout the process, we employ specialized wound care techniques including properly designed packing methods and strategic drainage to promote healing from the inside out, preventing premature closure of the external wound before the deeper tissues have healed.
This comprehensive approach ensures not only technical excellence during your procedure but also optimal post-operative management, giving you the best chance for complete healing and minimized recurrence risk while preserving normal bowel function and continence.
Immediate Post-Procedure (1-7 days)
Expect moderate to significant discomfort for the first several days
Receive specialized pain management including both oral medications and topical treatments
Begin sitz baths (warm water soaks) 24 hours after surgery, continuing 2-3 times daily
Learn proper wound care techniques, including cleaning after bowel movements
Maintain properly placed packing if used (may be removed at first post-op visit)
Take prescribed antibiotics if indicated to prevent infection
Use stool softeners and fiber supplements to avoid constipation
Expect some bleeding or drainage from the surgical site, typically decreasing over time
Rest and avoid prolonged sitting or strenuous activities
Keep the surgical area clean and dry between sitz baths
Manage pain with prescribed medications taken on schedule
Prepare for your first follow-up visit, typically scheduled 5-7 days after surgery
Short-Term Recovery (1-4 weeks)
Attend your follow-up appointment where the surgeon will assess the healing progress
Continue sitz baths after bowel movements and 2-3 times daily
Maintain a high-fiber diet and adequate fluid intake to prevent constipation
Monitor the wound for proper healing from the depth outward
Expect ongoing drainage that gradually decreases as healing progresses
Recognize that discomfort gradually improves, though complete comfort may take weeks
Avoid heavy lifting (nothing over 10 pounds) for at least 2-3 weeks
Return to work based on your surgeon's recommendation and job requirements:
Desk jobs: typically 1-2 weeks
More physical jobs: may require 3-4 weeks
Modify activities to accommodate healing and avoid undue pressure on the surgical area
Continue prescribed wound care regimen, which may include specialized cleansing or packing
Begin gentle walking for exercise as comfort allows
Report any signs of infection or significant increase in pain promptly
Understand that healing occurs from the inside out, requiring patience during this process
Long-Term Recovery (1-3 months)
Continue attending follow-up appointments to monitor healing progress
Recognize that complete healing of a fistulectomy wound typically takes 4-8 weeks depending on the size
Gradually increase physical activities as the wound heals and comfort improves
Resume normal activities, including more strenuous exercise, as cleared by your surgeon
Monitor for any signs of recurrence, including new drainage or pain
Maintain dietary habits that promote soft, regular bowel movements
Observe the gradual closing of the wound from the base upward
Expect significant improvement in original symptoms as healing progresses
Begin transitioning from specific wound care to normal hygiene routines
Address any concerns about bowel function or discomfort with your healthcare team
Notice continued improvement in comfort during sitting and daily activities
Understand that some patients may require additional procedures for complete healing
Follow any specific recommendations for patients with underlying conditions like Crohn's disease
Long-Term Expectations
Complete healing typically occurs within 2-3 months for most fistulectomy patients
Expect a small, well-healed depression or scar at the surgical site
Recurrence rates vary based on fistula complexity:
Simple fistulas: 5-10% recurrence
Complex fistulas: 10-30% recurrence
Crohn's-related fistulas: higher recurrence rates without optimal medical management
Preservation of normal bowel control and sphincter function in most patients
Return to all normal activities without restrictions once healing is complete
Need for ongoing management of underlying conditions that may have contributed to fistula formation
Implement preventive measures to reduce recurrence risk:
Proper perianal hygiene
Management of any underlying conditions (Crohn's disease, etc.)
Proper fiber intake and hydration
Prompt attention to any perianal infections or abscesses
Annual follow-up is recommended for the first few years to monitor for recurrence
Excellent long-term quality of life following successful healing
Most patients experience complete resolution of drainage, pain, and discomfort
Rare cases may require additional treatments for residual symptoms
Common Side Effects
Pain or discomfort around the surgical site, typically significant for 1-2 weeks
Bleeding or drainage from the wound during healing
Temporary difficulty with hygiene until healing is well-established
Mild to moderate swelling in the perianal area
Discomfort during bowel movements in the early recovery period
Itching or irritation around the wound as healing progresses
Need for ongoing wound care for several weeks
Temporary restrictions on physical activities
Discomfort when sitting for prolonged periods
Temporary dietary modifications to manage bowel movements
Less Common Complications
Infection of the surgical site requiring antibiotics or additional treatment
Delayed healing, particularly in patients with underlying health conditions
Recurrence of the fistula requiring additional procedures
Incomplete removal of the fistula tract leading to persistent symptoms
Formation of an ectropion (outward turning of anal canal lining)
Anal stenosis (narrowing) from excessive scar tissue formation
Fecal incontinence, particularly after surgery for complex fistulas
Urinary retention requiring temporary catheterization
Bleeding requiring intervention beyond simple pressure
Persistent pain beyond the expected healing period
Damage to sphincter muscles affecting bowel control
Development of additional fistula tracts
Psychological impact from prolonged healing process
Missed diagnosis of underlying conditions (Crohn's disease, malignancy)
When to Seek Immediate Medical Attention
Excessive bleeding (more than a few tablespoons)
Severe, increasing pain not controlled by prescribed medications
Fever over 101°F (38.3°C)
Significant increase in swelling, redness, or warmth around the surgical site
Purulent (pus-like) or foul-smelling discharge
Inability to urinate for more than 6-8 hours after surgery
Significant constipation or inability to have a bowel movement for several days
New or worsening incontinence of stool or gas
Reopening of a previously healing wound
Severe spreading redness or streaking from the wound site
Significant increase in drainage after a period of improvement
Severe restriction in movement due to pain
Development of new pain in a different location
Signs of systemic infection including chills, severe fatigue, or confusion
From your first consultation through your complete recovery, we provide:
Thorough evaluation and explanation of your condition
Clear discussion of all treatment options, including non-surgical alternatives when appropriate
Detailed pre-operative instructions to help you prepare
Compassionate care during your hospital stay or outpatient procedure
Comprehensive follow-up care and support during recovery
Ongoing availability to address questions or concerns
We understand that facing head and neck surgery can be intimidating, but you don't have to navigate this journey alone. Our team is committed to providing expert care with a personal touch, ensuring you feel supported, informed, and confident every step of the way.
Your health and wellbeing are our highest priorities, and we're honored to be part of your care team.
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All our laparoscopic procedures are performed by our highly trained surgical team using state-of-the-art equipment and techniques.
We're committed to providing you with the most advanced, minimally invasive options because we believe you deserve:
Less pain after surgery
Shorter hospital stays
Faster return to work and activities you enjoy
Smaller, less visible scars
Lower risk of complications
Better overall outcomes
Dr. Richard Nguyen is a board-certified General Surgeon with over 20 years of surgical expertise and fellowship training in Minimally Invasive and Bariatric Surgery from Vanderbilt University. Since establishing his practice in San Jose in 2007, he has pioneered innovative surgical techniques, including single-incision laparoscopic procedures and mastery of the da Vinci Robotic Surgical System. Beyond his acclaimed bariatric surgery practice, he has earned national recognition for his specialized expertise in both non-mesh and advanced mesh hernia repairs, while also serving as a critical approach surgeon for anterior spine access procedures. Dr. Nguyen combines technical precision with personalized care across multiple premier facilities throughout the South Bay Area.
I would refer Doctor Nguyen to anyone, in fact I have and they have all had the same experience as me. He is truly great. I owe all my success to Doctor Nguyen and I thank him for all the work he has done for me and continues to do so. He is extremely amazing, and I am very grateful to him.
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At 50, I now have a life I had only dreamed of a year before. My body tells me if I am done eating. This surgery is a tool that I have used to the fullest. It is not an easy way out. It still took work. But I honestly know that I would not be living this amazing new life if I didn’t step forward to embrace this life-saving surgery.
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Dr. Nguyen has changed my life completely. I feel so much better and I also feel like I’ve got control of my life again…I had high blood pressure, diabetes and cholesterol. I took at least 5 different medications for the past 30 years. NOW, after surgery I take no medications only vitamins!
Wondering which surgical procedure might be right for your condition? We're here to help you understand your treatment options and develop a personalized surgical plan. Contact our office today to schedule a consultation.
Your path to improved health may be more achievable than you think—with advanced surgical techniques leading to faster recovery, reduced complications, and a significantly enhanced quality of life.