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Anal Fistula

Anal Fistula

An Anal Fistula refers to an atypical tunnel or path that connects the anal canal (anus) to the skin of the buttocks. In healthy individuals, this tunnel does not exist, and fecal matter within the anal canal should be contained within it.

The primary symptom of an anal fistula is typically staining of underwear, with many patients seeking medical attention after noticing yellowish stains or a small amount of feces on their underwear. This is often misdiagnosed as fecal incontinence, but the age of the patient can serve as a giveaway, as fecal incontinence typically affects the elderly or those who have undergone previous anal surgery.

The second most common symptom is the presence of a small pimple-like lump near the anus or on the buttock, which may be minimally tender. Some patients may report having discharged yellowish fluid or feces from the lump.

An anal fistula often begins with an infection that originates from the anal glands in the anal canal and progresses towards the skin of the buttock. This infection can cause a swollen pocket of infected tissue and liquid called a perianal or ischiorectal abscess, which can either rupture spontaneously or require surgical drainage. In some cases, the initial channel remains open, resulting in the formation of a permanent abnormal channel that connects the anal canal and the skin.

Crohn’s Disease is an underlying condition that can cause anal fistulas in a small number of cases, and patients with this disease may experience multiple fistulas that do not heal.

Anal Fistulotomy

The most common and effective treatment for anal fistulas is an anal fistulotomy. This procedure involves opening up the fistula tract and cleaning it to promote healing. During the surgery, part of the anal sphincter muscle is divided in order to maintain fecal continence. However, if the surgery is performed carefully and the muscle is not divided too much, the risk of fecal incontinence is minimal.

Ligation of Inter-Sphincteric Fistula Tract (LIFT Procedure)

The LIFT (Ligation of Inter-Sphincteric Fistula Tract) procedure is a technique developed by Prof Arun Rojansakul. here is minimal risk of faecal incontinence when dealing with complex fistulas or high fistulas.

Two-stage surgery with Seton

The two-stage surgery approach with Seton is to insert a suture or rubber band through the fistula channel, anal canal, and external skin. This involves placing the seton in the first stage and performing either a fistulotomy or a LIFT procedure in the second stage. The goal of using a seton is to gradually reduce the channel by allowing the suture or rubber band to cut into it over time. This increases the likelihood of success and reduces the likelihood of complications in the second surgery.

Recovery Process after an Anal Fistula Surgery

This will require regular washing during baths and after passing motion. No particular dressing is required except for a pad to be placed over the underwear to soak up any discharge from the wound.

A LIFT procedure involves a much smaller wound with the same type of care as above. A seton does not require much care other than regular washing and to avoid tugging on the suture or rubber tie.