Posted in: mediapage | December 6, 2012 at 4:37 pm , by Times of India
A fistula is defined as the connection of two body cavities or as the connection of a body cavity to the skin (such as the rectum to the skin). This is not a normal occurrence. One way a fistula may form is from an abscess (pus in the body). The abscess may be constantly filling with body fluids such as stool or urine, which prevents healing. Eventually the fistula breaks through to the skin, another body cavity, or an organ. ANAL FISTULA:An anal fistula is almost always the result of a previous abscess. Just inside the anus are small glands. When these glands get clogged, they may become infected and an abscess can develop. A fistula is a small tunnel that forms under the skin and connects a previously infected anal gland to the skin on the buttocks outside the anus. SYMPTOMS Symptoms of fistulas can include.• Pain• Discharge — either bloody or purulent (pus)• Pruritus ani — itching• Systemic symptoms if abscess becomes infected CAUSES :· An anal fistula usually develops after an anal abscess (a collection of pus) bursts. When an abscess has not been completely treated.· A fistula can also be caused by conditions that affect the intestines, such as Crohn’s disease or ulcerative colitis.· A growth or ulcer (painful sore)· A complication of surgery· A health problem you were born with TREATMENT:There are many types of surgical treatments options for fistula. A few commonly advised options depending on the type of fistula are as follows.1) Fistulotomy or 2) Fistulectomy :Oldest and the best studied of all the methods. In this surgery, the fistula tract is laid open by cutting out the whole tract with knife [Fistulotomy] or the fistula tract is totally taken out [Fistulectomy]. The resultant wound is generally not closed and left open to heal of its own. This way the chances of recurrence are decreased.It is considered as a good option for Low Fistulas but is not recommended for High fistulas.ADVANTAGESHigh success rates in Low FistulasDISADVANTAGES· Pain- This surgery leads to a large wound from the anal opening to the buttock. Understandably this leaves the patient with lot of pain in the post operative period.· Invasive- The procedure is associated with a lot of cutting, scarring and distortion of the anatomy.· Long Hospitalization- The patient generally needs hospitalization for 4-8 days or even longer.· High morbidity- The patient requires dressings for 4-6 weeks and is obviously off the work for this time.· High recurrence rates- In spite of all these difficulties, this surgery is associated with a high recurrence rate.· Risk of Incontinence- The procedure has a definite risk of incontinence especially in high fistulas. 3) Video Assisted Anal Fistula Treatment (VAAFT):This technique involves use of an endoscope called Fistuloscope and is done in two stages. In the first stage the scope is introduced through the external opening to identify the internal opening by locating where the light is reflected on the anal wall. This is the Diagnostic step. In the next step a suture [purse string] is taken around the internal opening so as to close it snugly. A semicircular stapler or linear stapler is could also be used. Then the fistula tract is debrided with a fistula brush and the scrapings sent for histopathological examination. Fibrin glue is injected near the inner end [now closed] and coagulation of the whole wall is done with the electrode. Simultaneously, the scope is withdrawn and the therapeutic procedure is over.