An anal fistula is an abnormal communication between the perianal skin and the inside of the anus. It is usually caused by infection of the glands that are located between the 2 muscles that surround the anal canal. Symptoms include: pain, purulent or blood-stained discharge and a painful lump in case of an abscess. Fistulae may involve the anal muscles to a different degree and they may have branches making them more difficult to treat.
The treatment must be carried out by a surgeon with a special interest in the field and ideally by a colorectal surgeon, since the risk of incontinence if not properly treated is high. A specialized surgeon will exactly tailor the treatment in order to minimize or avoid any risk of incontinence that will grossly affect the quality of life.
There are several techniques available and the knowledge of them allows to adopt the appropriate treatment to the right patient. A Seton, a suture thread or rubber material can be inserted into the fistula to prevent infection while waiting for definitive treatment. If the fistula is very low, involving a minimal amount of muscle, this can be laid open with minimal risk of incontinence and high chance of success.
In case of a higher fistula with involvement of a greater amount of muscles, techniques can be used to avoid cutting any part of the muscles and help healing the fistula. VAAFT (Video-assisted treatment) has the advantage of cleaning the tract, visualizing side branches and burning its inner surface stimulating healing. A similar mechanism is the basis of laser treatment (FILAC). Sometimes some materials may used in addition to these treatment to fill the tract, like fibrin glue or Permacol. The LIFT technique s a very good procedure and allows dividing the fistula between the muscles to make it heal.
An important addition to the video or laser techniques is the closure of the internal orifice. If all these techniques fail then an advancement flap technique can be used. This brings fresh, viable tissue to cover the internal orifice. Anal fistula treatment
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