An anal fistula is an abnormal tunnel that forms as a result of an infected anal gland located inside the anus. The tunnel usually develops from inside the anus to the skin surrounding the anus. Due to an infected anal gland, there is the formation of abscess or pus which slowly bursts or drains into the external skin surrounding the anus.
Some of the most common symptoms associated with anal fistula include:
Fistulas can be classified based on their complexity and relationship to the sphincter muscles.
Based on their relationship to sphincter muscles, it can be:
Simple Fistulas: Simple fistulas are relatively straightforward in their anatomy and have minimal involvement of the sphincter muscle. They are typically low-lying and involve minimal branching. Simple fistulas are more accessible to treat and have a lower risk of complications and recurrence.
Common types of simple fistulas include Intersphincteric Fistula and Low type Transsphincteric Fistula.
Complex Fistulas: Complex fistulas are more intricate and involve a more significant portion of the sphincter muscles.
They may have multiple tracts and openings, making them more challenging to treat. Complex fistulas are more likely to recur and have a higher risk of complications.
Examples of complex fistulas include High Transsphincteric Fistula, Suprasphincteric and Extrasphincteric Fistulas.
Diagnosing a fistula in ano typically involves a combination of medical history, physical examination, and imaging studies. Imaging studies help plan the appropriate treatment strategy.
Imaging studies such as MRI (Magnetic Resonance Imaging) or Endoanal Ultrasound are often used to map the fistula tract and determine its complexity.
Several treatment options exist for the management of fistula in ano. The choice of treatment depends on the type and complexity of the fistula and the patient’s overall health. Here are some of the best treatment options:
Laser Treatment for Anal Fistula: Laser treatment for fistula in ano is a minimally invasive procedure that uses laser energy to ablate the fistula tract. This treatment has gained tremendous popularity due to its precision, reduced postoperative pain, and faster recovery compared to traditional surgical methods.
The procedure has its indications, and not every patient is a candidate for laser surgery. Extremely complex fistulas, excessive branching of fistulas, and fistulas associated with abscess formation are some of the contraindications of this procedure.
The procedure's success depends upon the surgeon’s experience and expertise, the quality of laser machines and patient selection.
Some of the common advantages of Laser Treatment for Fistula include:
Minimally Invasive: Laser treatment is less invasive than traditional surgery, resulting in more minor wounds and less tissue damage.
Reduced Postoperative Pain: Patients typically experience less pain after laser treatment compared to conventional surgical methods.
Faster Recovery: The recovery time is generally shorter, allowing patients to return to normal activities sooner.
Zero Risk of Incontinence: The precision of the laser reduces the risk of damaging the sphincter muscles, which can help preserve continence.
Less Scarring: The procedure results in minimal scarring compared to more invasive surgical techniques.
Outpatient Procedure: Laser treatment can often be performed as an outpatient procedure, reducing hospital stay times.
VAAFT is a minimally invasive technique that uses a thin scope to visualize the entire fistula track through the camera. This allows for complete cleaning of the tract, identifying the internal opening, and closing the internal opening with a unique stapler.
VAAFT is particularly useful for complex fistulas and offers the advantage of preserving the sphincter muscles.
VAAFT was introduced a few years back but became disreputed due to its high recurrence. However, this procedure has delivered excellent results with the combination of laser therapy.
After closing the internal opening, laser energy is used to ablate the entire track. This laser-assisted VAAFT technique has given excellent results.
LIFT is a surgical technique that is used in the management of complex trans-sphincteric fistula. It significantly reduces the chances of faecal incontinence by preserving sphincter muscles.
The procedure involves accessing the fistula tract between the internal and external sphincter muscles. The tract is ligated and divided, allowing it to heal from the inside out. To maximize the best outcomes, the distal tract is ablated with the help of laser energy.
Seton wiring involves placing a seton (a piece of surgical thread or wire) through the fistula tract to allow continuous drainage and promote healing. Seton wiring is particularly useful for high or complex fistulas.
There are two types of setons:
Cutting setons: Also known as Ksharsutra, the setons are coated with unique materials which gradually cut through the fistula tract.
Non-cutting setons: These are used to keep the tract open for drainage and are simple cotton or silk sutures.
Medicines alone are usually not effective in treating anal fistula. While medications, such as antibiotics and anti-inflammatory drugs, can help manage symptoms and reduce infection, they do not address the underlying issue of the fistula. Surgical interventions are usually required to resolve the condition fully.
The effectiveness of laser treatment depends on various factors, including the type, complexity, and location of the fistula, as well as the patient's overall health and medical history. Laser procedures are usually not recommended for highly complex fistulas, fistulas with extensive branching or ramifications and associated abscess or pus formation.
Dressing is usually not required after the laser procedures. However, you might be given specific instructions regarding post-operative care and maintaining adequate hygiene.
The recovery is relatively rapid after undergoing laser surgery for fistula in ano. Since there is no wound, you can quickly return to normal activities within three to four days. You can start taking baths from the next surgery day and begin driving after a couple of days.
The fistula plug is a biocompatible device made from materials like porcine intestinal submucosa or synthetic polymers. It is designed to fill the fistula tract and promote healing.
The plug is inserted into the track through a minor surgical procedure. However, the recurrence rates are high with this procedure. Fibrin Glue is a biological adhesive composed of fibrinogen and thrombin. Fibrin glue is injected into the tract, sealing and promoting tissue healing. Although painless, the results are not very promising due to higher recurrence rates.
The likelihood of an anal fistula recurring after laser treatment is relatively low but not zero. Studies suggest that recurrence rates are usually around 2-5%. The proper patient selection can further reduce these recurrences, using high-quality laser machines and fibres and choosing a well-experienced surgeon with a proven track record of successful outcomes.
Ksharsutra treatment is quite painful, especially during the initial stages, when the thread is first inserted, and subsequent changes. However, this treatment is often favoured in traditional Indian medicine (Ayurveda) and may be recommended for patients having complex fistulas. This treatment prevents sphincter injury and has a lesser chance of recurrence.
Availability of a complete range of procedures conducted by a team of highly experienced and internationally trained surgeons.
Empanelment with some of the best hospitals for fistula surgery, with state-of-the-art facilities, ensures excellent outcomes.
Zero per cent Interest EMI options.
Complete cashless facilities with all insurance companies.
Advanced, USFDA-approved 1470 nm laser machines of the highest quality.
Extensive Experience: Dr. Kapil Agrawal has 22 years of experience performing advanced procedures for anal fistulas.
High Volume of Successful Surgeries: He has performed over 2,000 fistula surgeries with excellent outcomes.
Comprehensive Care Team: He has a dietician team who guides the surgical journey.
Expertise in Latest Procedures: Dr Agrawal is skilled in all the latest procedures for anal fistula treatment.
Customized Treatment Plans: He offers personalized treatment plans tailored to each patient’s medical history and the complexity of their fistula.