● The anal fistula is an abnormal tunnel-like opening near the anus that connects the infected anal gland or infection sac that was blocked to release its contents inside the anal region. This results in the release of infected content near the anus on the outside.
● Mostly foul-smelling liquid, pus, or blood oozes out from the fistula.
● An anorectal abscess is the main cause of the anal fistula. When anorectal glands get infected and blocked, it leads to the formation of an anal fistula.
● Medical conditions of colons like Crohn’s disease, diverticulitis, ulcerative colitis, etc.,
● Complications of infectious diseases like tuberculosis and sexually transmitted diseases- HIV
● Anal or rectal cancer
● Post anorectal surgery complication
● Swelling and tenderness in the anal area
● Itching or redness around the anus
● Discomfort and irritation in the anal area
● Constant throbbing anal pain that worsens on conducting a bowel movements, or even causing pain at the anal area while sitting or coughing
● Pus, blood or foul-smelling liquid discharge near the anus
● Bowel movements accompanied by pain and bleeding
● In rare cases, uncontrolled bowel movements
● If you are experiencing a painful bowel movement with pus or blood discharge and constantly throbbing pain in the anal area, then yes, you are eligible for anal fistula treatment.
● An anal fistula is an abnormal opening in the anal region. Surgery is needed for its permanent closure and healing.
● Our clinical team consists of Dubai’s leading proctologist. They make use of digital rectal examination, Proctoscopy, Colonoscopy, MRI Fistulogram, and Fistulography to assess the extent of the infection and treatment protocol.
At MEDSTAR, we provide the latest procedures available for the fistula in Dubai. The patient does not have to worry about complications and post-surgery pain. We have treated patients with all types of Anal fistula with almost a 0% recurrence rate. FiLaC (Fistula Laser Closure) is performed for general fistula whereas, DLPL(Distal Laser Proximal Ligation), a specially devised technique for complex fistula ensures the patient goes back home from the hospital the very same day with a smile on their face.
At MEDSTAR, our proctologists are Dr. Ashwin Porwal and Dr. Shailesh Matkar. They have successfully cured rare cases of different types of fistula, like those extending from rectum to abdomen ( Recto-abdominal ), rectum to the groin ( Recto-inguinal ), rectum to the tailbone (Recto-nidal ). Also, they are well-known proctologists not only in Dubai but across the globe for treating complex fistula.
● Anal fistulas if dentified and treated early on may heal by themselves but effective treatment for most anal fistula infections via surgery.
● Surgery for an anal fistula usually requires general anaesthesia and in many cases, the patient can go home the same day.
● Surgery aims to heal the fistula without damaging sphincter muscles, the ring of muscles of the anus, to avoid loss of bowel control.
● Surgical procedures for anal fistula treatment are:
○ Fistulotomy: This is the most common surgical procedure for anal fistula. In this procedure, the fistula is given a cut to open it up so it drains its content and heals as a flat scar.
○ Seton techniques: A seton is a surgical thread that's left in the fistula for weeks to keep it open, allowing it to drain and heal. This procedure is used to avoid other procedures that need to cut the sphincter muscles.
○ Advancement flap procedure: This procedure involves cutting or scraping the fistula and covering it with a flap of tissue taken from inside the rectum to avoid damaging the anal sphincter muscles.
○ LIFT procedure: The Ligation of the Intersphincteric Fistula Tract (LIFT) procedure is used to treat the fistula passing through the anal sphincter muscles. In this procedure, the anal sphincter muscles are moved apart by cutting the skin above the fistula. Then fistula is sealed at both ends and cut open so it lies flat.
○ Endoscopic ablation: In this procedure, an endoscope (a tube with a camera on end) is inserted into the fistula. Then an electrode is passed through the endoscope to seal the fistula.
○ Laser surgery: In this procedure, a radially emitting laser fiber device is used to seal the fistula with the help of a laser beam. This is the most advanced and safe fistula treatment option known.
○ Fibrin glue: This is the only non-surgical option for anal fistulas in which glue is injected into the fistula by the surgeon to seal the fistula and heal it.
○ Bioprosthetic plug: In this procedure, a cone-shaped plug made from animal tissue called a bioprosthetic plug, is used to block the internal opening of the fistula.
● Fistulectomy is a surgical procedure in which the fistula tract is completely excised under general anesthesia and left behind to heal.
● This procedure is mostly used for complex fistula as this procedure has the disadvantage of damaging the anal sphincter muscle resulting in faecal incontinence.
● Laser is used with Fistulectomy to minimize the damage to the anal sphincter muscle.
The VAAFT is used for the surgical treatment of complex fistulas and is performed with the use of a fistuloscope in 2 phases:
● Diagnostic phase: In this phase, the surgeon will identify the external opening of the tract to insert the scope. After inserting the scope, the entire tract and any accessory tracts are delineated.
● Treatment stage: In this phase, the inner portion of the tract is fulgurated from the internal opening towards the external opening to clean the tract and close the external opening.
● Advantages of VAAFT
○ No surgical wounds
○ Identifies the precise location of the internal opening
○ No damage to the anal sphincter muscle
● The biggest disadvantage of VAAFT is the high rate of recurrence of fistula.
● In this procedure, a seton is first placed in the fistula tract, forcing it to widen over time. A few weeks later, infected tissues are removed by the surgeon and the internal fistula opening is closed.
● This procedure is used to treat Complex or Deep fistulas.
● The advantage of the LIFT procedure is to avoid any damage to anal sphincter muscles, with a high success rate in treating fistulas.
● The fistula plug is made up of 100% synthetic bio-absorbable material and the plug is placed inside the tract of the fistula. Over the period, it gets completely absorbed and new cells are formed inside the tract resulting in the healing of the fistula.
○ Less pain and faster recovery
○ No surgical wounds
○ No damage to the sphincter muscle
○ Dislodgement of the plug from the fistula tract
○ Infection of plug
● FiLaC ( Fistula-tract Laser Closure ) procedure gently removes the fistula tract without damaging the sphincter muscle.
● In this procedure, a radially emitting laser fiber device is inserted from the external opening of the fistula. The laser beam destructs the fistula tract.
● This procedure requires short General Anesthesia and is completed in about 30-40 minutes.
○ Excellent healing rate in comparison to other fistula treatments
○ There is no post-surgery incontinence as anal sphincter muscles are preserved.
○ This procedure can treat complicated fistulas like recto-inguinal and recto-gluteal fistulas.
○ The procedure is safe for patients with hypertension, heart disease, and diabetes and for elderly patients.
○ Temporary local burning due to heat emitted by the laser.
○ A post-operative subcutaneous abscess that is treated by medications and topical dressings.
○ In rare cases, an incision is required for the drainage of the pus under local anesthesia.
Fistula is a complex condition. Conclusively, the principal aim of any fistula treatment is not only to get rid of the existing fistula but:
Most fistula procedures like VAAFT, LIFT, and FiLaC achieve the main goal of closing the fistula and preserving the sphincter to avoid incontinence. However, all the treatment options have their recurrence rate. We are well aware of how worrisome a fistula is, even a minute chance of recurrence can raise a concern for the patient.
● In this procedure, an abscess cavity along with the internal opening is excised and then the distal tract is closed. The proximal part of the fistula tract is then sealed with the use of Leonardo Laser. The radially emitting fiber of the laser emits energy circumferentially to the fistula tract. This results in the complete closure of the tract.
● Dr. Ashwin Porwal has invented the DLPL technique. IN HIS SERIES OF 100 PATIENTS WITH COMPLEX HIGH FISTULAS CURED WITH DLPL, NOT A SINGLE CASE OF RECURRENCE OR INCONTINENCE WAS RECORDED.
● Advantages :
○ Anal sphincter muscles are saved from surgery, preventing incontinence
○ Not stitches result in fast healing of the fistula without any risk of infection
○ There is no recurrence of fistula after this procedure
● Fistula surgery with laser is a same-day procedure. However, it takes 3-12 weeks to completely heal the anal fistula.
● The use of the latest procedures and lasers have made our treatment options at MEDSTAR highly effective, with the lowest rate of recurrence and complications post fistula surgery.
An anal fistula is an abnormal opening near the anal opening of the infected blocked anal gland. This gland fails to drain inside the anal region and forms another external opening near the anus through which it releases its contents.
This abnormal opening called anal fistula does not heal on its own and needs surgical treatment for permanent healing.
Symptoms of Fistulas are:
● Constant throbbing anal pain
● Frequent abscesses
● Foul-smelling discharge
● Painful bowel movements with or without anal bleeding
● Anal skin irritation
● Enlarged swollen lymph nodes
These symptoms might go off for some time, but they recur till the permanent healing of the infected gland or tissue connected with the fistula.
Fistulas can cause a lot of discomfort and serious complications if left untreated. All symptoms like anal pain, anal bleeding, fever, and pus discharge will worsen if left untreated. These worsened symptoms can easily hamper the daily routines of the patient.
In advanced cases, fistulas can be a source of infection, which might spread to the whole body and can lead to low blood pressure, organ damage, or even death.
Mostly fistulas do not heal on their own without medical treatment. They might close for some time due to a decrease in the infection of the tissues but tissue might get infected again and the tract may reopen due to repeated infection. So surgical treatment is necessary to completely heal them and prevent the recurrence of fistulas.
if proper treatment and care are taken after the fistula treatment, a fistula usually will not recur. A fistula may, however recur if not taken care of by a specialist and experienced colorectal surgeon. Even if it recurs after the treatment, there are treatment options like DLPL recommended to cure them.
At MEDSTAR, we provide long-lasting fistula healing treatment with the help of our experienced surgeons and newly devised technologies.
It may take 3-12 weeks for the anal fistula to heal completely. The patient has to take complete rest for the first 24 hours after surgery. Usually, the patient can resume daily life routines after 3-5 days post-surgery.
The time taken for the complete healing of the fistula also depends on the medical condition and age of the patient.
Lasers are the most effective treatment for fistulas. Laser procedures are painless, resulting in excellent fistula healing without post-surgical wounds. These procedures preserve the anal sphincters so that patient can control bowel movement post-surgery. The recurrence rate of the fistula is also low after laser treatment.
At MEDSTAR, we have highly skilled surgeons to treat anal fistulas with the use of lasers.
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