What is Anal Fistula?

An anal fistula is a small channel that can develop between the end of the bowel and the skin near the anus. An anal fistula can cause bleeding and discharge when passing stools – and can be painful.

An anal fistula can occur after surgery to drain an anal abscess. In some cases, an anal fistula causes persistent drainage.

In other cases, where the outside of the channel opening closes, the result may be recurrent anal abscesses. The only cure for an anal fistula is surgery.

Symptoms of anal fistulas

Pain, which is usually constant, throbbing and worse when patient is sitting down, Skin irritation around the anus, including swelling, redness and tenderness, Discharge of pus or blood, Constipation or pain associated with bowel movements. Infection may worsen and lead to perianal sepsis leading to Fever.

Ignored fistula will keep making tunnels branching below skin or in rectum leading to multiple communication.

Ignored fistula patients may come with complains of stool and gas passing through fistula opening.

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Video Assisted Anal Fistula Treatment

Video-assisted anal fistula treatment (VAAFT) is a novel minimally invasive and sphincter-saving technique for treating complex fistulas. Karl Storz Video Equipment is used. Key steps are visualization of the fistula tract using the fistuloscope, correct localization of the internal fistula opening under direct vision, endoscopic treatment of the fistula and closure of the internal opening using a stapler or cutaneous-mucosal flap. Diagnostic fistuloscopy under irrigation is followed by an operative phase of fulguration of the fistula tract, closure of the internal opening and suture reinforcement with fibrin thrombin glue.

The main feature of the VAAFT technique is that the procedure is performed entirely under direct endoluminal vision. With this approach, the internal opening can be found in 82.6% of cases. Moreover, fistuloscopy helps to identify any possible secondary tracts or chronic abscesses. The VAAFT technique is sphincter-saving, and the surgical wounds are extremely small.

Advantage

  • Non Invasive little pain, early recovery back to work quickly
  • If Failure can be used again
  • Very Low risk of incontinence
  • Very good Minimally Invasive approach for complex deep seated abscesses and fistulas esp Crohn’s Fistulas
  • VAAFT can be combined with any other technique like Seton and standard open surgical Method by being able to directly visualize and reach high internal opening

Disadvantage

  • Risk of reopening of internal Fistula opening
  • Risk of Recurrence and Multiple Surgeries

FAQ

What is a Fistula in ano ? What causes anal Fistula ?

Fistula is a tract (passage) which communicates between two surfaces or body parts. Anal Fistula is an abnormal passage (communication) between the interior of the anal canal or rectum and the skin surface around the anus.Most fistulas begin as anorectal abscesses. When the abscess opens spontaneously into the anal canal (or has been opened surgically), a fistula may occur. Approximately, 8-50% of perianal abscess patients end up having an anal fistula.

Other causes of fistulas include tuberculosis, cancer, injury (trauma), Crohn’s disease, after Radiation therapy, anal Fissure, and infections (actinomycoses, chlamydial etc). Fistulas may occur singly or in multiples.

Rarely, the fistula may communicate from anus (rectum) to Vagina (Recto-Vaginal Fistula), Urinary Bladder (Recto-Vesical Fistula), Urethera (Recto-Uretheral Fistula) or other pelvic structures, including the bowel

What happens in Anal Fistula ?

Symptoms are usually a purulent discharge and pus coming around opening of asshole anus. It can irritate the outer tissues causing itching and discomfort. Pain occurs when fistulas become blocked and abscesses recur. Gas may also escape from the fistulous tract. A fistula-in-ano is diagnosed when a probe has been passed between the opening on the skin’s surface and the interior opening.

What are Anal Fistula risks ? Is it really dangerous?
  • If the treatment is not done, the pus inside the fistula can spread further leading to formation of multiple tracts and several opening in the skin around the anus. This makes the fistula more complex and further difficult to treat.
  • Anal Fistula treatment is associated with high recurrence rate. Anal fistula treatment requires a lot of planning and each patient require expert handling. Therefore, Anal Fistula should always be treated by an expert Colo-Rectal Surgeon who has special interest in dealing with Anal Fistulas.
  • Another important issue is that each and every fistula is different one cured with one modality may not be useful for other. It has to be understood by patient and surgeon that each patient will require a customised treatment as per status of his disease. There are different procedures to treat Anal Fistulas and none of these procedures is perfect. Therefore, different procedure should be done in different patients, depending upon the type and complexity of that patient’s fistula.
  • There is a risk, though low, of cancer formation in the long standing Anal Fistulas. Therefore, Fistulas should always be treated at the earliest.
What is KsharSutra / Sharsutra / Seton treatment for fistula ?

“Kshar Sutra” (क्षारसूत्र) is a sanskrit phrase in which Kshar (क्षार) refers to anything that is corrosive or caustic; while Sutra(सूत्र) means a thread. It is one among popular Ayurvedic treatment modality in the branch of Shalyatantra followed by Susruta.
The Ksharsutra was first mentioned by the “Father of Surgery” in his text named SUSHRUT – SAMHITA for the treatment of Nadi Vrana(sinus),Bhagandara (fistula- in – ano).How kshar sutra works is common question what is chemical of ksharsutra are commonly questioned but its a chemical seton which mainly help in drainage of pus and chemical cauterization.

What are foods to avoid Fistula ?

Diet for fistula patient is a common question.Healthy foods without spices and low salt no chilies help in quick recovery. Diet should be rich in fibre.

What yoga and exercise help to prevent and cure fistula ?
Gentle walk and yoga is helpful in good bowel habits which also play key role in treatment of fistula.
what is role of anal sex ? When can i have anal sex after fistula surgery

Anal sex is not recommended in persons with anal fistula and it should be avoided till complete recovery from fistula.

What is treatment of fistula without surgery
As such there is no definitive treatment without surgery though antibiotics only help in suppression of infection

What of Role Medicine for fistula treatment
No specific medicines are helpful except antiobiotics help in resolution of infection but until source of infection is removed cure can not be expected.

What is role of VAAFT surgery in Crohns disease
Medical Control of Crohn’s disease is must be treated with medicine once it is controlled vaaft helps in good control of fistula
What is role of Home treatment of fistula and natural remedies for fistula
Good local hygiene is the key of fistula treatment with surgery. No herbal drugs for fistula alone work it needs to be combined with one or other surgical modalities. Control of constipation and inflammatory  bowel disease  is very important in fistula treatment.

what is Best diet for fistula patient? what is SCD Diet?
Best is to take proper diet with combination of Speicific Carbohydrate Diet also know as SCD diet. SCD is reported to be helpful in patients of crohns Disease, Ulcerative colitis and fistulas associated with inflammatory bowel disease.
What is cost of fistula treatment ? VAAFT Surgery cost
Cost of procedure varies from hospital to hospital and room category of patient and deping upon complexity of situation and disease and length of stay LOS in hospital
What is VAAFT surgery for piles
There is no vaaft surgery for piles VAAFT (video assisted anal fistula treatment) for fistula treatment.
What are complications of VAAFT procedure
There is no major complcations associated with VAAFT risk of injury to anal control mechanism is lowest in this technique. Recurrence of disease is possible which is possible in any other modality.

VAAFT Surgery Videos Patient Education Information & Testimoneal

Dr Ashish Bhanot

Chief Of Bariatric Surgery & Surgical Gastroenterology Nova Hospitals

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