• Anal fistula, or fistula-in-ano, is a common anorectal problem. In this condition, an abnormal communication develops between the inner surface of the anorectal tract and the skin around the anal verge.
• Due to blockage of the anal gland output channels, secretions accumulate inside and an abscess forms the anal fistula.
1) Fistulotomy: The fistulous tract is cut open. One the tract is open, it is converted into a groove and is allowed to heal from within
2) Fistulectomy: It comprises of excision of entire fistulous tract. A probe or dye inserted into the tract from one opening to the other defines the entire tract. Then the tract is excised
In both the cases area is kept open and is allowed to heal from within.
• These methods best identify the fistula tract or path with its internal and external openings,
• Highly effective surgical treatment to destroy the fistula path,
• Damage to the sphincter muscles in a very small number of patients – this may affect the bowel control and can lead to faecal incontinence It requires prolonged period of painful dressing which may be extended for weeks or months.
• Re-occurrence – there is a chance that the fistula may recur in a small subsets of patients
3) Setons (Staged Procedure):
If the fistula passes through a significant portion of anal sphincter muscle, a seton can be recommended initially. A seton is a piece of surgical thread that is left in the fistula for several weeks to keep it open. This allows it to drain and helps it heal, while avoiding the need to cut the sphincter muscle.
4) Video Assisted Anal Fistula Treatment(VAAFT):
It is the minimally invasive technique. This technique is suited for surgical treatment of complex anal fistulas and their recurrences. This technique comprises of two phases: Diagnostic and Operative. A small scope is introduced through the external opening of the fistula and then the whole tract is probed. The internal opening is closed with suture or surgical stapling device.
• No surgical wounds on the buttocks or in the perianal region
• No damage to the anal sphincters
• Early recovery
• Can be done as a Day-Care procedure
• Fistulous tract can be completely destroyed from within, without damaging any other tissues
• Though there are no such worth mentioning disadvantage of VAAFT, but is has its own limitations.
• If the nature of the anal fistula is too complex, then open surgical method is preferred over VAAFT
• Chance of recurrence is around 20% of cases