Symptoms:

• Recurrent anal abscess.
• Pus Discharge from the boil near anal region
• Pain at anal region
• Swelling at anal region.

Symptoms usually get worse without an operation. The type of surgery you need will depend on where the fistula is:

Below the sphincter muscle

Through the sphincter muscles

Above the sphincter muscle

TYPE OF FISTULA INCLUDES

• Blind fistula in ano: Opens on one end only, but connects to two structures.

• Complete fistula in ano: has opening both outside & inside the body.

• Horse-shoe Fistula in ano- connects & the anus to the surface of the skin after going around the rectum.

• Incomplete- a tube form the skin that is closed on the inside as does not connect to any internal structure.

Treatment:

For an anal fistula surgery is the only treatment. In our clinic we do

Sphincter sparing procedures for Fistula in ano

• Fistula Plug

• VAAFT

• Laser Surgery

• Fixation device

• Ksharsutra Ligation

Fistula Plug –

Fistula plug is a minimally invasive treatment for complex fistula. It doesn’t require cutting into the Sphincter. This minimizes the risk of postoperative incontinence. There is a medical fistula brush catheter is pulled into the fistula tract for 2-4 weeks & then an absorbable fistula plug is inserted in the fistula track. Drainage can occur for up to 12 weeks after the procedure occur for up to 12 weeks after the procedure as the plug is incorporated & the fistula track is closed.

Fistula Laser Closure (FiLaC):

The FiLaC procedure was performed using a ceramic diode laser platform (12 watts, 1470-nm wavelength). The laser fiber was introduced into the fistula tract via the external orifice using the seldinger maneuver until the internal orifice was found. The fiber delivered laser energy homogenously at 3600, causing shrinkage of the fistula tract around the fiber while it was withdrawn at the speed of 1 mm/sec. It is a novel sphincter saving procedure for the treatment of anal fistula. Primary closure of the track is achieved using laser energy united by a radial fiber. This procedure is basically ‘reality’ the fistula by laser energy. This procedure for Fistula in and is safe, minimally invasive sphincter saving procedure and a high chance of success.

VAAFT: (Video assisted anal fistula treatment)

The endoscopic procedure VAAFT treatment is a painless technique for complex fistula in ano and will leave behind no surgical wound on the buttocks of fistula patients. Nor, will it damage anal sphincter. Vaaft is a surgical kit. The system comprises with- A video telescope (Fistuloscope) to allow surgeon to see inside the fistula tract. This helps in locating internal opening of fistula. A unipolar electrode for diathermy of the internal tract.

A Fistula brush and forceps for cleaning the tract is cleaning dead granulation fissure and after that fistula tract is sealed.

Advantages:

• The video fistuloscope given the operating surgeon greater control area the procedure as visualization of the tract & its branches helps to identify the exact course of the fistula & its internal opening

• Helps to avoid creation of a false tract.

• VAAFT is claim to be the only technique that allows the surgeon to see inside the anal fistula treat & locate the internal opening.

• Day care procedure

Fixation Device:

In an attempt to improve the quality of life of patients with high anal fistula. A new advanced mechanical device a “Fistutectome” which excises the fistula tract in a totally controlled manner. The principle of the treatment is to excise approximately 2mm thickness of the fistula tract circumferentially, which in fact is a “coring out” procedure. This procedure is a minimally invasive, safe, is effective method to be considered in the treatment of particularly “High and fistula” so that they will be no recurrence rate as it is still a nightmare to operate this kind of fistula in ano.

Ksharsutra Ligation:

Ksharsutra ligation is the treatment of choice in most patients suffering from Fistula in Ano. Ksharsutra is a popular Ancient Ayurveda treatment modality in India for the management of fistula-in-ano. It works by the action of excision, scraping, draining, penetrating, debridement, and sclerosing as well as healing simultaneously without a surgical excision. Most commonly practiced surgical “lay open” technique to treat fistula-in-ano (a common anorectal pathology) has high rate of recurrence and anal incontinence. Alternatively, a nonsurgical cost- efficient treatment with Ksharasutra (cotton Seton coated with Ayurvedic medicines) has minimal complications.