Fistulas Fistulas

Fistulas

Anal Fistulas

Fistula Treatment in Faridabad, Delhi Ncr

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Fistula in ANO

A fistula-in-ano is an abnormal hollow tract or cavity that is lined with granulation tissue and that connects a primary opening inside the anal canal to a secondary opening in the perianal skin; secondary tracts may be multiple and can extend from the same primary opening.

A fistula-in-ano is an abnormal hollow tract or cavity that is lined with granulation tissue and that connects a primary opening inside the anal canal to a secondary opening in the perianal skin; secondary tracts may be multiple and can extend from the same primary opening.

Causes of Fistula formation:

Just inside the anus, there are several glands that make some secretions. Sometimes, the opening of these glands gets blocked. When this happens, a bacteria buildup can create swelling-filled pus and infected tissue (anorectal abscess).

If we don’t treat the abscess timely, it’ll grow. Eventually, it’ll make its way to the outside through a hole in the skin somewhere near the anus so the pus inside it can drain. The fistula is the tunnel that connects the gland to that opening.

Most of the time, an abscess causes a fistula. It’s rare, but they can also come from conditions like tuberculosis, sexually transmitted diseases, or an ongoing illness that affects the intestine, such as Crohn’s disease or ulcerative colitis

Classification for general understanding:

Anal Fistula can be broadly divided into Simple Fistula and Complex Fistula

  • Simple fistulae are those with a single tract and involves less than 30% of the external anal sphincter.
  • Complex fistulae are those with multiple tracts, involves more than 30% of external sphincter, recurrent or arises due to pre-existing medical disease like Crohn’s disease.
  • Simple fistulae are relatively easier to treat, associated with lesser complications and has minimal chances of recurrence.
  • Complex fistulae are difficult to manage, has higher chances of recurrence and associated with higher complication rate.
Fistula Treatment in Faridabad

Symptoms of Anal Fistula

  • Pain and swelling in the anal area
  • Redness of skin around the anus
  • A boil-like opening near the anus, possibly with:
    • Pus discharge
    • Bleeding
  • Fever

Challenges in Treatment of Anal Fistula:

  • Preservation of sphincter function
  • Prevention of recurrence

Treatment Offered:

In the acute phase, a simple incision and drainage of the abscess are sufficient. 7-40% of patients develop a fistula after abscess formation. Recurrent anal sepsis and fistula formation are twofold higher after an abscess in patients younger than 40 years and are almost threefold higher in non-diabetics.

Fistulotomy/Fistulectomy

The laying-open technique (fistulotomy) is useful for 85-95% of primary fistulas. A probe is passed into the tract through the external and internal openings. The overlying skin, subcutaneous tissue, and internal sphincter muscle are divided with a knife or electrocautery, and the entire fibrous tract is thereby opened. Complete fistulectomy creates larger wounds that take longer to heal and offers no recurrence advantage over fistulotomy.

 Seton Placement

A seton can be placed alone, combined with fistulotomy, or in a staged fashion. This technique is useful in patients with the following conditions:

  • Complex fistulas (ie, high transsphincteric, suprasphincteric, extrasphincteric) or multiple fistulas
  • Recurrent fistulas after previous fistulotomy
  • Anterior fistulas in female patients
  • Poor preoperative sphincter pressures
  • Patients with Crohn disease or patients who are immunosuppressed

Beyond giving a visual identification of the amount of sphincter muscle involved, the purposes of setons are to drain, promote fibrosis, and cut through the fistula. Setons can be made from large silk sutures, silastic vessel markers, or rubber bands that are threaded through the fistula tract.

Diversion

In rare cases, the creation of a diverting stoma may be indicated to facilitate the treatment of a complex persistent fistula-in-ano.

Laser Fistulotomy: An almost painless and bloodless procedure usually indicated for simple, low-level fistula. The track is laid open with the help of laser fiber.

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