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27 Oct 2016

Fistula


A fistula is an atypical link formed between two organs or structures as a result of some traumatic injury, previous botched surgery or even an infection. There can be a fistula formed between artery and vein, vagina and anus, uterus and peritoneum and at many other places. A fistula can be blind that has opening at one end, complete that opens inside and outside of the body, incomplete which is kind of tube closed inside the body without linking to other body part and finally a horseshoe shaped fistula that goes around one organ open outside the body and connect to another part. The horseshoe fistula is common in anal region.

An anal fistula is predominantly an outcome of previous abscess, almost 50% of cases patients have suffered with an abscess before. The internal part of anal region is composed of multiple small glands. Any of these glands if get clogged, an infection takes place forming a cavity. A fistula is formed that links the blocked cavity and the infected glands. However, a fistula can definitely form in the absence of abscess too, below the skin and opening outside the body close to anus

Ano-rectal fistulas are classified based on their position and connection to the specific part of the anal sphincter. The categorization is helpful for experts while diagnosis and treatment. The most common kind of fistula of anus is the intersphincteric fistula.

Causes

As stated earlier fistula in majority of cases is resultant of an abscess. There are other conditions that are cause of fistula-in-ano such as Crohn’s disease, a colon condition due to inflammatory bowel disorder; cancer, tuberculosis or trauma.

Symptoms

Pain, redness of anal skin and swelling are the most common symptoms of fistula. In addition there is at times mild to high body temperature observed if the fistula is consequential to an abscess. At instances there is urinary bleeding and pain accompanying urination or difficulty in urination. Annoying itchiness, draining of stool, pus or blood from the outside opening of the fistula and rectal bleeding has also been observed. A detailed patient medical history study and a thorough physical examination help doctor deduce the degree of condition and exact position and amount of damage. At time there are tissues amassed at the exterior opening visible, a clear indication of well established tract.

Treatment

In 99% cases fistula are untreatable through medication nor alternatively with any other therapy. Other than surgery currently there is no other cure possible. Mostly colon and rectal expert doctors are needed for such procedures. They initially assess the exact dimension of the fistular tract. If the fistula a simple with narrow anal sphincter involvement, fistulotomy is a good option wherein the un-roofing of the tube is done, thereby nicking the skin and muscles creating an unwrapped groovy section. The procedure allows the tract to mend by its own inside out. The major disadvantage of fistulotomy is that the sphincter muscles are divided during the procedure due to which the continence of patient gets impacted. Therefore the surgeon has to cautiously weigh the options before they take a call. The damage cannot be undone.

Fibrin glue injection is an option that would obliterate the tract and the glue possible fills up completely, slowly integrating with the adjoining tissues. Nevertheless, the failure rates are on the higher side but the associated risks of patient’s continence is negated and the procedure can be repeated. A fistula plug is an alternative to the glue with the plug getting incorporated throughout the length of the tract working similarly as the glue. Again the chances of accomplishment are merely 50%.

Endoanal advancement flaps are secured for complicated fistulas, yet the success rate is low if there is reported malignancy, previous procedures done or special condition such as Crohn’s disease. LIFT is also an alternative to fistulotomy to avoid division of sphincter muscles, yet the complete efficacy and frequent use of the procedure is still not established to recommend with full proof result.

At Koya Stopiles Clinic, the experts and surgeons provide accurate treatment for complete relief from fistula and ward off the conditions that possibly extend into future relapse to their best knowledge.




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