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Fistula

An anal fistula, is also called as fistula- in -ano, it is a small channel that develops between the end of the anal canal and the skin near the anus. This is a painful condition, especially when the patient is passing stools. It can also cause bleeding and discharge during defecation.

Almost all anal fistulae occur due to an anorectal abscess that begins as an infection in one of the anal glands. This infection spreads down to the skin around the anus causing fistula-in -ano. The anorectal abscess usually leads to pain and swelling around the anus, along with fever. Treatment for anorectal abscess involves incising the skin over the abscess to drain the pus. This is done usually under local anesthesia. A fistula-in-ano happens when there is failure of the anorectal abscess wound to heal completely. Almost 50% of patients with an abscess go on to develop a chronic fistula-in-ano.

SYMPTOMS

  • Pain- Constant pain which gets worse when sitting down
  • Discharge of blood or pus
  • Irritation around the anus, like swelling, redness and tenderness

TREATMENT

The only cure for an anal fistula is surgery. The type of surgery will depend on the position of the anal fistula. Most patients are treated by simply laying open the fistula tract to flush out pus, called Fistulotomy. This type is used in 85-95% of cases and the fistula tract heals after one to two months.

  • Seton techniques: A seton is a piece of thread (silk, plastic) which is left in the fistula tract to treat anal fissures. This is used in high fistula where the patient is at risk of developing incontinence after fistulotomy.
  • Advancement flap procedures: When the fistula is considered complex, carrying a high risk of incontinence, then this advanced technique is used.
  • VAAFT: This is a novel, most advanced and minimally invasive way of treating complex anal fistula. Here the fistula tracts are visualized from inside with video assistance and the tract is fulgurated and closed

Other techniques like Fibrin glue and Bioprosthetic plug are also used to surgically treat anal fistulas. In the Fibrin glue technique, glue is injected into the fistula to seal the tract, after which the opening is stitch closed. Bioprosthetic plug is a cone shaped plug made from human tissue, which is used to block the internal opening of the fistula. After this stitches are used to keep the plug in place

Commonly performed Fistula procedures by Dr.Ankur Bansal are

  • Fistulectomy
  • Fistulotomy
  • VAAFT
  • Laser Surgery
  • LIFT
  • Seton Placement
  • Laser Surgery