WHAT IS ANAL FISTULA ?

Fistula in ano/Anal Fistula (also known as POWTHIRAM in tamil)is a tract or a tunnel lined by epithelium connecting the skin around the anus and the mucus membrane inside the anus. In simple words fistula is a tract or tunnel going from an external opening in the skin around the anus,transversing under the skin and piercing the sphincter muscles and going into the anus and opening into an internal opening inside the anal canal. Anal fistula is an infected tunnel between the skin and the anus.

HOW DOES THE ANAL FISTULA FORMS?

The majority of anal fistulas are caused by infections that begins in the anal gland.An abscess is created by the infection ,and it either drains naturally or is surgically removed via the skin adjacent to the anus.The anal canal or gland that is infected links to a hole in the skin outside of the anus through this drainage tunnel,which is left open.

WHAT ARE THE CAUSES OF ANAL FISTULA?

The most frequent cause of an anal fistula is an anal gland that has become infected with pus (abscess). Some diseases, including Crohn’s disease, can also cause a fistula. Or it could occur following cancer radiation treatment. Anal fistulas can also be brought on by surgery and anal canal injury.

WHAT ARE THE TYPES OF ANAL FISTULA?

Simple Fistula– When the fistula has no multiple branches and a straight tract.

Complex Fistula -When there are multiple branches and multiple openings

Low anal Fistula-When the internal opening is below the dentate line I.e.the anal fistula opens lower into the anal canal.

High anal Fistula-When the internal opening is above the dentate line i.e.the fistula opens higher up into the anal canal.

Multiple anal Fistula -When there are multiple anal fistula due to inadequate or late treatment of simple fistula or secondary to tuberculosis or inflammatory bowel disease or rarely gonococcal infections.

INTERSPHINCTERIC FISTULA-Where the fistula transverses the intersphincteric plane.

TRANSPHINCTERIC FISTULA-Where the fistula passes through the sphincters is called transphincteric fistula.

INTERNAL FISTULA-Mostly when there is no obvious external opening and the fistula is inside the anal verge,it is called internal fistula.

FISSURE FISTULA-When a chronic fissure erode into the tissues resulting in fissure fistula.

WHAT ARE THE SYMPTOMS OF ANAL FISTULA?

Usually presents with a swelling in the skin outside the anus which burst discharging pus and persistent wound/hole remains discharging pus

Pain and swelling around the anal area

Fever and chills

Feeling tired and sick

Redness, soreness, or itching of the skin around the anal opening

Pus drainage near the anal opening

Bleeding along with the stool

WHO ARE AT THE RISK OF GETTING ANAL FISTULA?

Had a perianal abscess or have in the past.

A Crohn’s disease or another inflammatory bowel disease (IBD).

Have had radiation or surgery in your perianal area in the past.

Persons who are vulnerable to more infections or have weaker immune systems.

Have a persistent STI.

WHAT ARE THE COMPLICATIONS OF ANAL FISTULA?

Untreated fistulas typically do not heal on their own. Long-term issues caused by this include:

Ongoing infection. An infection or abscess that develops a fistula may continue to spread. A new abscess may form and the pain may reappear after the infection appears to have subsided in the original location. The fistula may appear to be healing at times and may even seal at the entrance, but recurrent infection and drainage will eventually cause it to reopen.

Extension of a fistula. Rarely, a chronic fistula may grow in unexpected directions, forming new branching channels and skin holes. Repairing these intricate fistulas is extremely challenging.

Cancer. Anal cancer has occasionally been discovered in anal fistulas that have existed for a long time. Erosion and persistent inflammation have both been linked to cancer risk.

HOW TO DIAGNOSE ANAL FISTULA?

To dignose anal fistula our doctor DR.KUMAR can analyze it just through a physical examination and by history collection.

An anal fistula’s external opening is typically visible on the skin around the anus. It is very difficult to locate the internal fistula opening inside the anal canal. Effective treatment of an anal fistula requires knowledge of the whole course.

To identify the fistula tunnel following investigations are carried out ;

MRI FISTULOGRAM is the investigation of choice. The fistula,the course of fistula, the branches and the openings , the sphincter muscle and other pelvic floor components may be seen in great detail, as well as a map of the fistula tunnel.

Endoscopic ultrasonography(Endorectal ultrasound) can be used to detect the fistula, sphincter muscles, and surrounding tissues.

Fistulography is an X-ray of the fistula that shows the anal fistula tunnel thanks to an injection of contrast.

Examination under sedated. During a fistula inspection, a colon and rectal surgeon could advise anesthetic. This enables a complete examination of the fistula tunnel and can spot any potential issues.

WHAT ARE THE TREATMENT OPTIONS OF ANAL FISTULA?

FISTULECTOMY- many times the treatment of fistula in ano involves excision of the whole tract. This is known as fistulectomy.this can be done in simple fistula

FISTULOTOMY– Sometimes the fistula tract is laid open instead of excision of whole tract.This is called fistulotomy.

SETON KNOTTING – In cases of high fistula many times it may not be possible to excise or remove the whole tract in single surgery.So in cases of high fistula the thread known as seton may be inserted into the higher part of the fistula and the lower part of the fistula may be removed in stage one surgery.After two months the seton with the remaining fistula maybe removed in second stage.

A surgical thread called seton must be removed since it cannot be absorbed over time.To keep your fistula open long enough to drain all the discharge out, a surgeon coils the seton through it.A seton can also gradually cut through the fistula tract while also cutting through the muscle, allowing the tissue to recover.Finally,it aids in local tissue scarring so that the infection wont later pull apart.Later your surgeon might perform a fistulotomy or another treatment to seal the fistula and remove the drain.Your surgeon may decide to keep the seton drain in place forever if your fistula is brought on by a chronic conditions like,inflammatory bowel disease.

LIFT PROCEDURE– It stands for ligation of intersphincteric fistula.It entails closing (ligating) the portion of the fistula that travels between your two sphincter muscles (intersphincteric),typically with stitches before your surgeon may removes the entire fistula tract from this space or scrape out the infected tissue inside.This procedure typically happens after a seton knotting procedure.

VAFT- VIDEO ASSISTED FISTULA TREATMENT –In this telescope is passed through the fistula and the inner lining is cauterized and the internal opening is closed.

LASER TREATMENT OF FISTULA-Laser can be used for the treatment of fistula.Laser can be used for removing fistula -fistulectomy. Sometimes the laser can be used to cauterize the inner lining of the fistula. Laser is associated with faster recovery.

DR.KUMAR has huge experience in LASER TREATMENT FOR FISTULA and is expert in FISTULA TREATMENT AND FISTULA SURGERY and can be considered as one of the best doctor for FISTULA TREATMENT AND SURGERY