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Anal Fistula

What is Anal Fistula?

Anal fistulas are an abnormal connection between the organs. More specifically, it is an infected tunnel between the skin and the anus. It can result in pain, swelling and blood discharge, formation of a hollow cavity, lined with granulation tissue. It connects to a primary opening inside the anal canal.
These arise due to cryptogranular infections that lead to perirectal abscess formations, which is an acute inflammatory event. An inflammatory tract forms between the skin and the anal canal. We are experts in dealing with all critical cases of anal fistulas. Our specialized technologies have given us a ladder to successfully treat fistulas and performing fistula surgery.

What are the types of Anal Fistulas?

The Parks classification system relative to the sphincter muscle categorizes anal fistulas as follows:

        Intersphincteric fistulas: They track along the intersphincteric plane and end in the perianal skin
      Extrasphincteric fistulas: Start in the high canal; encircles all of the sphincter and ends in the skin of the buttocks
       Transsphinteric fistulas: Run across the external sphincter and go into the ischiorectal fossa ending in the buttocks’ skin
          Suprasphincteric fistulas: Encircle the complete sphincter and run through the anal crypt
There are two types of anal fistulas - Simple and complex.
        Simple anal fistulas are inclusive of intersphincteric and transsphincteric fistulas
      Complex anal fistulas are inclusive of suprasphincteric fistulas, horseshoe fistulas, extrasphincteric fistulas, and IBD related fistulas.

What are the Signs and symptoms of Anal Fistula?

      Persistent throbbing pain that worsens when sitting down
      Irritation of skin around the anus
      Swelling, redness and tenderness in the area surrounding the anus
      Pus or blood discharge
      Pain during bowel movements
      Abdominal pain
      Change in bowel habits
      Weight loss

How can anal fistula be diagnosed?
At the doctor’s clinic, first, a detailed history of symptoms will be asked. After this, an examination of the back passage will be done in a private and secure manner. In most cases, fistula can be diagnosed at this stage. To identify the type of fistula and its severity, imaging is mandatory.
Is surgery necessary for Fistula?
Anal fistulas require surgical therapy for proper and complete healing. Antibiotics are recommended for patients with sepsis or overlying cellulitis. We may prescribe oral pain relievers and stool softeners that aid in muscle relaxation and relief of anal spasms. Suppositories and ointments for the area may also be prescribed to reduce pain and swelling. Some suppositories may also help with lubricating the area for better stool passage. After determining the type of fistula and its severity, surgery is planned.
Four types of Fistula surgery are often done:
Fistula In Ano Laser Assisted Closure (FILAC): This is the latest and most advanced procedure in management of fistula. Using Laser, fistulous tract is closed. There is no pain, no bleeding and patient can be discharged in the same day or next day. They can return to work in 3 days
Fistulectomy: The fistulous tract is surgically removed completely.
Fistulotomy: The fistulous tract is laid open completely.

Seton: This procedure is done is complex fistulas and in high anal fistulas where the muscles that control the passage of stools is at risk. The principle of foreign body reaction, fibrosis and scarring is used to close the fistulous tract. A non absorbable suture thread is passed through the fistulous tract and tied. Periodic visit and repositioning of seton with help to close the fistula tract by scarring without compromising the sphincter function. Often this is done as a hybrid procedure with one of the above methods. 
The choice of Fistula surgery will depend on the nature of the problem. Any treatment must be decided based on your needs and situation, in consultation with the surgeon. Not all these procedures work in all scenarios. Therefore, careful consideration of the individual circumstances must be taken.
Why choose us to perform fistula surgery?
We report a high satisfaction rate because of our patient-centric approach and fewer complications. We will also make sure that no major illness or disease is missed while starting your treatment. If you have noticed blood or pus discharge around your bottom or  having discomfort while defecating, do feel free to pay us a visit so we can guide you on the best course of action.

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