Is anal fistula difficult to treat?

Is anal fistula difficult to treat? No, not at The Laser Gastroenterology Clinic, Chennai

An anal fistula is a medical condition wherein a tunnel-like passage forms inside the anus. It starts from inside the anus and ends somewhere on the skin outside the anus. There are different types of fistula depending on where they are formed.  Before knowing about them, you need to know that Sphincter muscles are the muscles around the anus using which the body controls the opening and closing of the anus when passing stools. Internal sphincter muscles are just behind the lining of the anus and after that external sphincter muscles are present. Any damage to these sphincter muscles can result in fecal incontinence. (ability to control stools will be lost partially).

Types of fistula

  1. Intersphincteric Fistula – This fistula begins from the inner lining of the anus and opens very close to the opening of the anus.
  2. Transphincteric Fistula – This fistula begins from the inner lining of the anus or space behind the anus.  It then crosses/cuts across the sphincter muscles and ends somewhere around one or two inches away from the anal opening.
  3. Suprasphincteric Fistula – This type of fistula starts on the inner lining of the anus, extends all the way upwards into the puborectal and levator ani muscles, and then turns down to open at around one or two inches away from the anal opening.
  4. Extrasphincteric Fistula – This one begins at the rectum (little higher inside the anus) or sigmoid colon and comes downward passing through the levator ani muscle and opens around the anus.

Diagnosis of fissures can sometimes be very challenging. The opening of the fistula has to be figured to fix it correctly. An expert gastroenterologist can guess the opening of the fistula by examining the location where it ends around the anus.   He/she will use either a fistula probe or anoscope to look inside the anus and locate the fistula opening.  There are several other ways of diagnosing an anal fistula but here, we will focus on the options that are employed by a gastro surgeon to treat fistula.

There is no medication that can be used to treat a fistula.  Surgery is the only option to drain, clear, and close the fistula and Chennai laser gastro clinic is one of the best hospitals in Chennai for Anal Fistula treatment and surgery

Treatment options for fistulas at our clinic

Even the treatment of fistula is quite a complicated surgery and the complexity depends on the location where it has formed. The main aim of the gastroenterologist will be to close the fistula, protect sphincter muscles from damage and avoid recurrence. As said, minor damage to sphincter muscles can lead to fecal incontinence.

  1. Fistulotomy – Once the internal opening is found, surgeon cuts it open and drains out the infected tissue. He/she then flattens it and stitches it up. More complicated fistulotomy will be required in cases where the fistula runs on both sides of the body.  In such cases, surgery may be done in two stages.
  2. Advancement rectal flap – The surgeon makes a flap from the rectal wall first. He/she then opens the fistula’s internal opening. The flap is then used to cover the internal opening.  This procedure reduces the amount of sphincter muscle that needs to be cut.
  3. Seton placement – Seton is a latex or a silk string that is run through the fistula. This will be held in place either for development of scar tissue around and/or drain the infection.
  4. Fibrin glue and collagen plug – The internal side of the channel is open and drained. It is then stitched and closed.  Special glue made from fibrous protein (called fibrin) is then injected through the fistula’s external opening. Then the other side of the fistula is also closed.
  5. Ligation of the intersphincteric fistula tract (LIFT) – This is a two stage treatment followed by the specialists at The Laser Gastroenterology Clinic in Chennai.  This has opted for complex and fistulas that run deep in the body. LIFT allows the surgeon to access the fistula that is between the sphincter muscles without cutting them. A seton (silk or latex thread) is placed into the fistula which will widen the fistula over time.  After few weeks, the infected tissue is removed and the internal opening is closed.
  6. Ostomy and Stoma – This is a more invasive procedure used to operate on closing complex fistula.  A temporary opening is made in the abdomen and the waste material from the fistula is drained into a collection bag. Eventually this will help the anal area heal.
  7. Muscle Flap – This too is a more invasive procedure. Tissue from thigh, labia or buttocks is taken to fill the fistula channel.

Some of these procedures do not need hospitalization. They can be performed as a daycare procedures. The experts at The Laser Gastroenterology Clinic are highly experienced in operating on simple and complex fistula alike. Call us or write to us if you are suffering from a recurring fistula for a permanent solution.

Dr. Karthik Gunasekaran