Anal Fistula Surgery
Surgery is typically essential to deal with anal fistula as they normally do not heal on their own. There are a number of different procedures. The very best alternative for you will certainly rely on the position of anal fistula and also whether it’s a solitary channel or branches off in various instructions.
Occasionally you might require to have a first evaluation of the location under general anaesthetic (where you’re asleep) to assist figure out the best treatment. This is called Examination under Anaesthesia. This can be done during the main surgery too. Proper communication and consents will have to be obtained about possible options to be used.
Your colorectal surgeon will talk to you concerning the choices available and which one they really feel is one of the most suitable for you. There are a few procedures, which became popular but long term results showed high recurrence rates and thus they fell by the way.
Surgical treatment for an anal fistula is typically executed under general anaesthetic. In most cases, one day overnight stay in the hospital is required afterwards.
Also See: Fistula Doctor in Chandigarh
The main goal of fistula surgery treatment is to heal the fistula while avoiding damage to the sphincter muscle mass, the ring of muscular tissues that open up as well as shut the rectum, damage to which might possibly cause loss of control (anal incontinence). The most commonly used procedures are:
One of the most common type of surgical treatment for rectal fistulas is a fistulotomy. This includes cutting along the whole size of the fistula to open it up so it recovers and heals from within. A fistulotomy is one of the most effective treatment for lr fistulas that do not go through a lot of the sphincter muscle mass, as the risk of incontinence is least in these cases.
If the specialist needs to cut a portion of anal sphincter muscle mass throughout the procedure, or the risk of incontinence is thought to be high, another procedure might be advised instead.
If a considerable portion of rectal sphincter muscular tissue is involved, a seton surgery will be done, which is inserted into the fistula tract running across the muscle. The rest of the fistula tract is excised and the wound laid open.
A seton is an item of medical string that’s left in the fistula for several weeks to keep it open. This allows it to drain and also assists it heal, while preventing the damage to the sphincter muscles. Loose setons permit fistulas to drain, however they do not cure them. They help in draining all the pus and infection over a span of weeks or months. Subsequently another surgery is required to use a tighter seton, which cuts the tract gradually over days or weeks. This way the sphincter gets time to heal and thus maintain continence.
At time, this may require numerous procedures that the doctor can go over with you. It may involve using a combination of the procedures depending upon the type of fistula. At times,
The procedure involves opening up a little section of the fistula each time.
Advancement flap surgery
An advancement flap treatment might be considered if your fistula travels through the rectal sphincter muscular tissues and other procedures have not given good results. This entails cutting or scraping out the fistula as well as covering the hole where it went into the bowel with a flap of tissue extracted from inside the rectum, which is the final part of the digestive tract. This is used very selectively as it carries a high recurrence rate. It may be used in conjunction with seton surgery.
There are some other procedures being used for treatment of anal fistulas recently and the long term success rates are either awaited or not very good. A few have shown good results in simple fistula. Some of the procedures are meant for specific fistulas and some just are alternate procedures. A few like fibrin glue, fistula plug and endoscopic ablation have shown higher recurrence rates. LIFT and laser ablation procedures will need more time to show long tern results, but could be used selectively for specific fistulas.
At this time, best results are shown by fistulotomy or seton techniques, but as said before the choice of surgery to be employed depends on the number, length, association with abscess, previous surgeries and underlying diseases. At times, a combination of procedures give the best result.
Risks of anal fistula surgery
Like any type of type of therapy, therapy for anal fistulas brings a number of risks. The primary risks are:
- Infection as this is a high bacteria colonized area because of the passage of stools.
- Recurrence of the fistula– the fistula can occasionally persist despite surgical treatment
- Faecal incontinence— this is a potential danger with the majority of types of rectal fistula treatment, although severe incontinence is uncommon and also every effort is certainly made to prevent it.
Things to remember about Fistula Surgery
Surgery is required for all patients with an anal fistula.
There are a few surgical options available to select from.
Each has its advantages and disadvantages.
Success is measured with low recurrence rates.
Choice of surgery depends on many characteristics of the fistula.
At times, a combination of surgeries are used.
Your surgeon is the best person to choose the correct treatment plan for you.