Treatment Anal fistula

anal fistula after surgical treatment



lay-open of fistula-in-ano — option involves operation cut fistula open. once fistula has been laid open packed on daily basis short period of time ensure wound heals inside out. option leaves behind scar, , depending on position of fistula in relation sphincter muscle, can cause problems incontinence. option not suitable fistulae cross entire internal , external anal sphincter.
cutting seton — if fistula in high position , passes through significant portion of sphincter muscle, cutting seton (from latin seta, bristle ) may used. involves inserting thin tube through fistula tract , tying ends outside of body. seton tightened on time, gradually cutting through sphincter muscle , healing goes. option minimizes scarring can cause incontinence in small number of cases, of flatus. once fistula tract in low enough position may laid open speed process, or seton can remain in place until fistula cured. traditional modality used physicians in ancient egypt , formally codified hippocrates, used horsehair , linen.
seton stitch — length of suture material looped through fistula keeps open , allows pus drain out. in situation, seton referred draining seton. stitch placed close ano-rectal ring – encourages healing , makes further surgery easy.
fistulotomy — till anorectal ring
colostomy — allow healing
fibrin glue injection method explored in recent years, variable success. involves injecting fistula biodegradable glue should, in theory, close fistula inside out, , let heal naturally. method perhaps best tried before others since, if successful, avoids risk of incontinence, , creates minimal stress patient.
fistula plug involves plugging fistula device made small intestinal submucosa. fistula plug positioned inside of anus suture. according sources, success rate method high 80%. opposed staged operations, may require multiple hospitalizations, fistula plug procedure requires hospitalization 24 hours. currently, there 2 different anal fistula plugs cleared fda treating ano-rectal fistulae in united states. treatment option not carry risk of bowel incontinence. in systematic review published dr pankaj garg, success rate of fistula plug 65-75%.
endorectal advancement flap procedure in internal opening of fistula identified , flap of mucosal tissue cut around opening. flap lifted expose fistula, cleaned , internal opening sewn shut. after cutting end of flap on internal opening was, flap pulled down on sewn internal opening , sutured in place. external opening cleaned , sutured. success rates variable , high recurrence rates directly related previous attempts correct fistula.


japan: man anal fistula. yamai no soshi, late 12th century.


lift technique novel modified approach through intersphincteric plane treatment of fistula-in-ano, known lift (ligation of intersphincteric fistula tract) procedure. lift procedure based on secure closure of internal opening , removal of infected cryptoglandular tissue through intersphincteric approach. essential steps of procedure include, incision @ intersphincteric groove, identification of intersphincteric tract, ligation of intersphincteric tract close internal opening , removal of intersphincteric tract, scraping out granulation tissue in rest of fistulous tract, , suturing of defect @ external sphincter muscle. procedure developed thai colorectal surgeon, arun rojanasakul, first reports of preliminary healing result procedure 94% in 2007. additional ligation of intersphincteric fistula tract did not improve outcome after endorectal advancement flap.
fistula clip closure (otsc proctology) latest surgical development, involves closure of internal fistula opening superelastic clip made of nitinol (otsc). during surgery, fistula tract debrided special fistula brush , clip transanally applied aid of preloaded clip applicator. surgical principle of technique relies on dynamic compression , permanent closure of internal fistula opening superelastic clip. consequently, fistula tract dries out , heals instead of being kept open continuous feeding stool , fecal organisms. minimally-invasive sphincter-preserving technique has been developed , clinically implemented german surgeon ruediger prosst. first clinical data of clip closure technique demonstrate success rate of 90% untreated fistulae , success rate of 70% recurrent fistulae.
perfact procedure latest addition armamentarium treat complex , highly complex fistula-in-ano. invented dr pankaj garg, minimally cutting procedure both anal sphincters (internal , external sphincters) not cut/damaged @ all. therefore, risk of incontinence minimal. perfact procedure (proximal superficial cauterization, emptying regularly fistula tracts , curettage of tracts) entails 2 steps: superficial cauterization of mucosa @ , around internal opening , keeping tracts clean. principle permanently close internal opening granulation tissue. achieved superficial electrocauterization @ , around internal opening , subsequently allowing wound heal secondary intention. results of procedure quite encouraging complex fistula-in-ano (86.4% in highly complex anal fistulae). procedure effective in fistula associated abscess, supralevator fistula-in-ano , fistula internal opening non-localizable.

infection

some people have active infection when present fistula, , requires clearing before definitive treatment can decided.

antibiotics can used other infections, best way of healing infection prevent buildup of pus in fistula, leads abscess formation. can done seton.