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An anal fistula is an infected tract that is formed between the skin and the muscular opening at the end of the anus. It is usually caused due to some anal gland infection. MRI Fistulogram is used to diagnose the condition.

Here are some treatment options for anal fistula, one of which is chosen by the surgeon depending upon the patient’s condition:

• Fistulotomy (Open treatment): It is the most effective treatment for many fistulas. This technique opens the fistula inside out and results in better and faster healing. The surgeon would cut the opening, scrape and clean the infected area, and then flatten and suture it back. Fistulotomy being an outpatient procedure, the patient can go home the same day.
• Laser fistulectomy: This procedure attempts to gently remove the anal fistula by using laser energy. It involves emission of laser fiber with a small laser beam to seal the fistula. There is no risk of infection, no cuts/incisions, patient can resume normal activities within a day and recover quickly.

Fistula is formed because of an abscess. If you have an anal abscess, there are good chances that you are prone to developing an anal fistula too.

Fistulas are formed due to certain conditions of the lower digestive or anal track like -

Fistulas are usually treated through surgeries for faster and better recovery. There are different types of treatment a surgeon might opt for depending on the patient's specific condition.

Fistulotomy 

The fistulotomy opens the fistula inside out and results in better and faster healing. The surgeon would cut the opening, scrape and clean the infected area, and then flatten and suture it back.

Fistulotomy usually involves cutting the sphincter muscle. 

Fistulotomy might be a complicated process when the entire channel needs to be removed, in that case, the process might be done in two stages.

Fistulotomy being an outpatient procedure the patient can go home the same day.

Filling the fistula (Collagen plus or Fibrin Glue)

This is a relatively new technique. This procedure uses a special glue or plug to close the inner opening of the fistula. The surgeon clears and cleans the channel and closes the input of the fistula with sutures. 

A special fibrous protein called fibrin is then inserted in the fistulas through the external opening of the fistula. 

The anal tract is then closed shut with a protein collagen plug.

Reconstructive surgery

Reconstruction surgery is usually done in stages and opted in some cases recommended by the surgeon.

 The reconstruction surgery is known as Ligation of the intersphincteric Fistula Tract (LIFT). This procedure is used to cure deep-seated fistulas. The procedure is done in stages several weeks apart.

Seton placement

The seton placement procedure uses a rubber band (seton), silk, or latex string inserted into the fistula to help drain out the infection.

For complex fistula, the doctor would recommend invasive procedures like-

Colostomy

Under this procedure, a temporary opening is made in the abdomen to divert all the waste and drain it into a collection bag. This allows time for the anal area to heal.

Muscle Flap

This procedure is out for complex anal fistulas, where healthy muscles from the thigh, buttock, or labia are used to fill the fistula channel.

Anal fistulas are more common in people with Crohn's disease. For patients with both Crohn's disease and a fistula, medical therapy is usually tried before surgery.

1. Overview: The fistulotomy opens the fistula inside out and results in better and faster healing. The surgeon would cut the opening, scrape and clean the infected area and then flatten and suture it back. 

2.Snapshots:

• Procedure Type: OPEN Surgery
• Anesthesia: Local anesthesia
• Hospitalization: Day-care
• Procedure time: An hour
• Recovery Time:  2-3 weeks

3. Post-Surgical Care: 

• Follow all instructions given by the surgeon
• Take medications as instructed
• Avoid strenuous activities
• Eating fiber-rich diet and drinking plenty of fluids
• Prefer sitting on soft/donut pillows to reduce pressure on your wound.

4. Advantages of this procedure: The cure rate of the procedure is high and is suitable for treating simple fistulas.

If you have a history of an abscess or symptoms of fistula, you should not miss these signs and contact your doctor immediately.

1. Overview: It is a minimally invasive procedure. This procedure involves emission of laser fiber with a small laser beam to seal the fistula.

2. Snapshots:

• Procedure Type: LASER Surgery
• Anesthesia: Spinal Block/General Anesthesia/Local Anesthesia
• Hospitalization: No hospitalization required (Day care)
• Procedure time: 30 minutes - 1 hour
• Recovery Time: 2-3 days

3. Post-Surgical Care: 

• Regularly change the dressing of the wound
• Use warm water and cotton to wash the skin and keep the area dry and clean
• Eating fiber-rich diet and drinking plenty of fluids
• Do not have sexual intercourse for at least 10 days
• Do gentle exercise and avoid lifting weights. 

4. Advantages of this Procedure: Cost-effective procedure, no risk of infection, no cuts/incisions, patient can resume normal activities within a day and recover quickly. The laser treatment does no harm to the skin, reproductive system, internal organs, or genitals of the patient.

If you are dealing with a fistula or recovering from a fistula treatment you can undertake the following practices for some comfort.