What is Anal Fistula?
An anal fistula is an abnormal tunnel-like tract that forms between the inside of the anus or rectum and the skin around the outside of the anus. It typically develops as a result of an infection in an anal gland, which causes an abscess (a collection of pus) to form. If the abscess does not heal properly and instead creates a passage to the skin’s surface, it becomes an anal fistula.
Common symptoms of an anal fistula include persistent anal pain, swelling, and recurrent abscesses or drainage of pus. Treatment often involves surgical intervention to drain the abscess, remove the fistula tract, and promote healing. Anal fistulas can be a chronic condition, and prompt medical attention is essential for proper diagnosis and management.
Types of Fistula in Ano
Intersphincteric Fistula: This fistula tract runs through the internal sphincter muscle of the anus and is one of the most common types.
Transsphincteric Fistula: Extending through both the internal and external sphincter muscles, this type of fistula often forms a visible opening on the skin near the anus.
Suprasphincteric Fistula: The tract in this type goes above the external sphincter and may involve the space between the sphincters.
Extrasphincteric Fistula: Extending beyond the external sphincter, this type may follow a more complex path, potentially involving surrounding structures.
Horseshoe Fistula: This type extends from one side of the anus to the other, forming a horseshoe shape.
Low Fistula: Located closer to the anal opening, low fistulas are generally easier to treat.
High Fistula: Situated deeper in the anal canal, high fistulas may be more complex and challenging to manage.
Symptoms of an Anal Fistula
Persistent Anal Pain: Discomfort or pain around the anal area, which may be ongoing.
Swelling: Swelling or a lump around the anus, especially if an abscess has formed.
Recurrent Abscesses: Formation of abscesses, which may lead to recurrent episodes of pain, swelling, and pus drainage.
Pus or Blood Discharge: Continuous or intermittent discharge of pus or blood from an opening near the anus.
Skin Irritation: Irritation or itching around the anal opening.
Fever: In cases of infection, individuals may experience fever and general malaise.
Painful Bowel Movements: Discomfort or pain during bowel movements, especially if the fistula is close to the anal canal.
Fistula Treatment
- Fistulectomy is a surgical procedure involving the complete removal of the fistula tract under general anesthesia. While effective for complex fistulas, it carries the risk of damaging sphincter muscles, potentially leading to complications such as bowel incontinence, abscess formation, or fistula recurrence.
- Ligation of the Intersphincteric Fistula Tract (LIFT) is a procedure suitable for fistulas passing through the anal sphincter muscle, where fistulotomy poses risks. Dr. Subash K G, a renowned colorectal surgeon, specializes in complex fistula surgery. The LIFT procedure involves placing a seton in the fistula tract, and gradually widening it. After a few weeks, the surgeon removes the infected tissue and closes the internal fistula opening, minimizing recurrence and incontinence.
- Fistula-tract Laser Closure (FiLaC) employs the Leonardo laser to gently ablate the fistula tract without harming the sphincter muscle. This minimally invasive procedure, conducted under general anaesthesia, takes approximately 30 to 40 minutes.
- Video-Assisted Anal Fistula Treatment (VAAFT) is a sphincter-sparing technique for complex fistulas. A video telescope aids surgeons in visualizing the fistula tract, and a polar electrode connected to a high-frequency generator is used to clean the tract and remove granulation tissue.
- The Fistula Plug involves placing a 100% synthetic bio-absorbable scaffold in the fistula tract. Over time, the body’s cells migrate into the scaffold, generating new tissue as the plug material gradually absorbs, leaving no permanent material in the body.
