What is fistula?
An anal fistula is a small tunnel that develops between the end of the rectum and the skin near the anus.Anal fistulas can cause unpleasant symptoms, such as boil, pain, discharge leading to discomfort and skin irritation, and will not usually get better on their own.
Treatments for an anal fistula
Surgery is usually necessary to treat an anal fistula as they usually do not heal by themselves. There are many procedures available but best option will depend on the position of fistula and whether it’s a single channel or branches off in different directions which can be assessed by doing MRI scan of rectum.
The aim of surgery is to heal the fistula while avoiding damage to the sphincter muscles.
Surgery offered at Zen hospital is mentioned below-
Fistulotomy- the procedure involves cutting along the whole length of the fistula to open it up so it heals as a flat scar.
Seton techniques- If your fistula passes through a significant portion of anal sphincter muscle, the surgeon may initially recommend inserting a seton which is a piece of surgical thread that’s left in the fistula for several weeks to keep it open.
This allows it to drain and helps it heal, while avoiding the need to cut the sphincter muscles.
LIFT procedure- The ligation of the intersphincteric fistula tract (LIFT) procedure is a treatment for fistulas that pass through the anal sphincter muscles, where a fistulotomy would be too risky.
In this, a cut is made in the skin above the fistula and the sphincter muscles are moved apart. The fistula is then sealed at both ends and cut open so it lies flat.
Laser surgery- Laser treatment for fistula-in-ano, also known as FiLaCR (fistula laser closure) or LAFT (laser ablation of fistula tract), has gained increasing attention in the last decade.
The procedure consists of delivering laser energy at 360° within the lumen of fistulas by means of a radial fiber which is slowly withdrawnacross the fistula tract.Laser ablation is limited to the lumen of fistulas making the technique ‘sphincter-saving’. The advantage of this procedure is that it is minimally invasive and safe procedure;hence chances of loosing control of stools are minimum and since no big wounds are made for the surgery, healing is faster and pain is minimal. However, the recurrence rates are high as in any complex fistula.
Other procedures used for treatment of fistula includes use of Fibrin glue for tract closure, Bioprosthetic plug, Advancement flap procedure, Endoscopic ablation, though results are not very promising.