​#fistula #analfistula #kimshospitals
Today we will discuss a very common problem faced by many people,which is called as Fistula problem. So what is Fistula ? There is an abnormal communication between the anal canal and the skin around the anus, or the skin around the buttocks, so when there is a gland inside the anus and it gets infected, the infected anal gland is filled with puss, so this puss sometimes, instead of bursting into the anus can track on the other side and find a way for itself to discharge out and that usually happens in the skin around the anus and this is called as fistula in anal. The patient comes with the complaint of a swelling around the anus, which is usually painless, but once in two three months this swelling enlarges, it ruptures and some amount of puss or some watery fluid comes out of the swelling, and the patient has this discharge or swelling for a week and then the swelling dries up and it becomes flat,the same story repeats every six months, this is a usualy history with which a fistula patient presents,rarely this swelling can become very painful, when the puss collection is more it can become an absyss and can cause symptoms like fever, extreme pain around the anal region, unable to even sit and it can even land the patient in severe sepsis and it can be bloody discharge from the skin around the anus, these are most common symptoms of the fistula.
Usually when the patient comes to the doctor with these symptoms, the gastroenterologist or the surgeon does a physical examination, and during that it is usually very obvious that whether there is a fistula or not, to further confirm the diagnosis we need a test called a sigmoidoscopy or a small endoscopy test, wherein the camera is passed into the anus and the entire anal canal is seen in magnification, to understand the entire course of the fistula or the complexity of the problem we usually do a test called an mr fistlogram is an mri scan where the fistula tract starting from inside the anus to outside the skin, what is the actual route taken by it, and what is the relation of the fistula tract to the muscles controlling the sphincter muscles, many times the most important challenge when someone is treating a fistula is to safeguard the anus sphincter, because in the course of surgery to treat a fistula , one should not injure the anal sphincter, if the anal sphincter or the valve mechanism is injured the patient might develop, incontinents or leaking of motions or gas after the operation, it is very important to know how the fistula tract related to the anal sphincter and that is very clearly shown in an mri scan, sometimes we also do an endo en ultrasound, where through the anus an ultrasound probe is passed and the fistula anatomy is delineated, so these tests are very important for surgical planning, meaning there are fistulas where they can be cured in a single setting, very complex fistulas might need two or even three sittings of surgery to be completely cured.
So what are the treatment options for fistula, because the fistula discharges puss many people think it is a normal infection and they keep taking antibiotics for a long time, some people come saying we’ve been taking antibiotics for the last 3 months and the puss is still not gone, fistulas do not get cured by antibiotic treatment, whenever there is an acute infection in the fistula tract like an abscess, those times a course of antibiotics is important, to clear the infection, but the fistula as such does not get cleared by the medicines alone, you need a surgery where the entire fistula tract, the skin around the anus, upto the connection into the anus is completely removed or destroyed, only then the fistula can be cured.There are various options to cure this fistula,all of them are surgical options, but the amount of injury it causes decreases with various techniques , we have conventional fistula surgeries, then we have endoscopic fistula surgery, then you have latest laser fistula surgery, the principle of all these treatments are same , but the amount of trauma which is caused in the fistula is different for each technique. Some fistulas are cured by a conventional fistula treatment wherein the surgery done, the fistula tract is completely cut and removed, and the area is sutured, and with newer advances, majority of the fistulas are treated with laser technique, where a laser fiber is passed into the fistula tract and with the help of this laser energy the fistula tract is destroyed, so as the laser fiber comes out it keeps destroying the fistula tract and thereby the tract collapses and the fistula is cured.
Dr. G. Parthasarathy
Sr. Consultant, Surgical Gastroenterology, Laparoscopic
& Hepato-Pancreaticobiliary Surgery
KIMS Hospitals Secunderabad