Anal Fistulectomy, Treatment of Anal Fistula

Fistulectomy is used to treat anal fistula, a condition that results due to infection in the anal canal .


Innovated Several Painless Techinques

Zero sphincter damage in the last 20 years of Fistulectomy


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anal fistula tract

Some of the glands in anal canal, at times, can become infected. The infection can then tunnel through the body and exit out of the surface of the buttocks. To protect itself from further spread of the infection, the body forms an epithelial layer on the surface of the tunnel. This is very similar to us humans lining a tunnel or a well with cement concrete.

This tunnel of infection, starting from the anal canal, often ending at the surface of the buttocks, is called an anal fistula. Sometimes, the fistula can form branches. The branches may not reach the surface of skin, making it difficult to locate and treat them.

Understanding Fistulectomy

“Ectomy” means “surgical removal”. “Fistul-ectomy” means “surgical removal of a Fistula”.

As we mentioned earlier, when the tunnels of fistula form, the body lines it with a layer of protection called the epithelium. Your intestine, for example, is lined with epithelium too. Epithelium, by its nature, doesn’t stick together (we don’t want our intestines to stick together, do we?). So, once the lining of epithelium forms, the fistula tunnels refuse to close.

When the layer of epithelium is removed or destroyed (provided the infection also is removed or treated), the body heals and closes the fistula tunnels.

There are many ways to achieve this. The traditional method consists of plucking out the tunnel, along with the infection. Other traditional method involves slowly cutting through the fistula tract using a silk thread.

Some times, a less painful method called plugging is used wherein, the infection is drained from the tunnel and it is filled with a collagen plug. Scar tissue eventually forms around the collagen.

The latest fistula treatment, called VAAFT (Video Assisted Fistula Therapy), involves using a video probe to travel through the tunnel and destroy the epithelium with controlled burning.

How is VAAFT Performed

With VAAFT (Video Assisted Fistula Therapy), the surgeon inserts tiny probe into the tunnel. The probe has a video camera attached to its end, with which the surgeon identifies the branches of the tunnel and destroys the epithelial lining by controlled burning.

The surgeon follows this by draining and treating the infection in the tunnels. With the epithelium, the body heals by closing the tunnels.

During the procedure, there is a risk of damaging the muscle that controls passage of stools (anal sphincter). But due to our vast experience in this field, here at LIMA, we have had a “zero” sphincter damage in the last 20 years of fistulectomy.

Burning of fistula wall in video assisted anal fistula therapy

Treatment window

Some cancers may present as a fistula. This is why fistulas need careful initial evaluation. Once cancer is excluded, the origin of   tract is identified and surgical intervention is recommended so as to avoid spread of infection to the deeper tissues.

Care After Fistulectomy

• Use warm water three times a day to wet the affected area.
• Use stool softeners to prevent constipation.
• Increase water intake and have fire rich food to have a good bowel movement.
• Maintain a healthy bowel.Don’t give a chance for another abscess. So chance of getting another fistula can be avoided too.
• Wear a gauze pad if needed. This can protect your clothes from the drainage.
• Kindly follow the advise from your surgeon after the surgery for faster recovery.

Fistulectomy FAQ

Yes, it is true that compared to other diseases in the anus, the fistula has high incidence of recurrence. But, hopefully you will not get it again. LIMA have a very high first time cure rate close to 98%. It is impossible to have a 100% first time cure rate, as the nature of the disease itself causes recurrence.
Even in the best of hands and with the best of MRIS’s, small tracts of infection may hide in and around the anus and  missed. This will present with a recurrence in a few months. It is documented that a 100% first time cure rate is impossible.
Most of the time NO. But some cancers (colloid cancers of the colon and rectum) can present with a fistula as their first appearance. This is why every fistula need a careful evaluation.
No, not more expensive than another operation! At LIMA, we would prefer to get an MRI for every patient with perianal infection as this imaging modality often gives us much more information than simply looking at the patient and palpating the area. Our first time cure rates have increased perceptibly after deploying the MRI as a routine imaging technique.
Yes. We do the VAAFT every now and then, but it is a technique that is associated with a higher recurrence rate than the other techniques like LIFT or Core fistulectomy. Certainly if the patients main concern is to go back as soon as possible, we would choose the VAAFT technique and we were among the first to use this technique on a routine basis in the country.
At LIMA, over the period of past 19 years, not a single patient developed incontinence after a fistula surgery.

However, it is true that unplanned and radical surgery for fistula can sometimes result in a loss of control of the motion. We have ourselves operated upon several patients to correct the loss of control, resulted from fistulectomy done elsewhere. However, if a proper MRI is done before the operation and this is taken into account during the surgical procedure, the risk is very low.

Plug is a minimally invasive technique wherein we pull a collagen plug through the entire fistulous tract and encourage it to fibrose and block up all the tracts. It is associated with very minimal pain, but again, like the VAAFT, it has a higher recurrence rate. One needs to have all the modalities of treatment in ones hand and use one or the other according to the needs of an individual patient.

Fistulectomy specialists

Dr. J. S. Rajkumar

CHIEF SURGEON

M.S., F.I.C.S., Dip. N.B. (SURG.), F.R.C.S. (ENG.), F.R.C.S. (EDIN.), F.R.C.S. (GLASGOW), F.R.C.S. (IRELAND), F.I.M.S., F.A.I.S., F.R.M.S. (LONDON), F.A.E. (GASTRO), F.A.C.G. (USA), F.I.C.A. (USA), F.I.A.G.E.S., Dip M.I.S. (FR.)


Dr. R. Prabhakaran

Consultant Surgical Gastroenterology
M.B.B.S., M.S. (GENERAL SURGERY), M.Ch. (SGE), DLAP, FACRASI

Dr. S. Akbar

Consultant General and Laparoscopic Surgery
M.B.B.S., M.S (GENERAL SURGERY), D.MAS, F.MAS.