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  • Dr. Ashish Ganatra

Treatment of Fistula in Ano & Rectovaginal Fistula, made EASY

Updated: Jan 12, 2019

We have seen that the patient & many times, even the operating doctors are scary of Piles & Fistula surgery. The main reasons for this are –

1. Fear of incontinence [loss of control for passage of stools]

2. Fear of developing stricture [smaller hole, so inability to pass stools]

3. Painful big cuts, wounds

4. Prolonged healing – prolonged dressings which are painful & time consuming

5. Prolonged rest – loss to earning capacity

6. Bad, Ugly scars with permanent pain

Thus Benign Proctology is now a recognised Super speciality in surgical field. With the advent of newer techniques, the procedures for treatment of Piles, Fistula, Fissure or Prolapse of Rectum doesn’t require incisions, thus avoiding wounds, & hence no dressings. These procedures give better results with faster recovery & no fear of loss of control for passing stools. Though a little expensive due to use of disposable items, they are worth return of money due to their benefits –

1. Faster recovery & early return to work

2. No dressings, so save on time & money

3. No bleeding, no scars

4. Minimal pain

5. No fear of loss of control

6. Safe in Diabetes, Hypertension, Heart diseases

7. Recognised by Mediclaim system

What is a Fistula in Ano –

It is a hollow tract lined by un-healthy granulation tissue with one opening in the Anal canal, mostly about 2-3 cms inside the anal verge, and another opening may be anywhere, most commonly on buttocks, but may be in the perineum, inguinal regions, vagina, etc.

Usually the patient initially presents with a boil over buttock, which bursts open & then recur or with persistent pus discharge from perianal region. Patient might have associated history of pain, fever, constipation, etc. There might be previous h/o operated for abscess drainage.

On examination usually the openings are seen and MRI of the region gives a very good delineation of the tract in 3D format.

As fistula is a disease of anal region with sphincters closing the anal verge, its physics itself suggests that it cannot heal with medicines. So surgery is a must, and yet it’s not the sure solution as the chances of healing vary. Till years the surgery was to put Seton in the tract to drain out the pus and then cut/lay open the tract or to cut out the whole tract giving a deep, long scar over the buttocks. It used to require prolonged daily, painful dressings. The fear of disturbance with the sphincter muscles leading to varying degree of incontinence was the most dreaded complication of these surgeries.

But now, few non-invasive or minimally invasive techniques have come up with better results and outcome with lesser morbidity leading to faster recovery. They are –

1. Glue – though seem promising initially, but the long term results are very poor.

2. LIFT/SLOFT – The results are variable, gives a small scar which further requires few dressings, easy to learn and cheaper

3. VAAFT/MAFT – Videoscopic treatment, has many limitations, expensive instruments, variable results

4. PLUG – Plugs the whole tract, leading to closure, variable results, but recent reports are promising, Very fast recovery, Expensive, yet worth return of money

5. CLIP – Not much tried, variable results, though expensive, needs further trials

6. Tube in tube technique – Minimal scarring, prolonged healing time, but much cheaper with results still to be evaluated

7. TROPIS – Very cheap and good method, Results yet to be evaluated, initial results very good & promising

8. Expanded Adipose derived Stem cells – promising experimental results, yet to come commercially in the Indian market.

The complex anal fistula remains a challenging condition to manage despite the best of the technologic advances. Thus a Colorectal Specialist needs to be consulted for best outcome, having developed skill & art of treating various types of Fistulae.

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#surgery #preoperative

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