A fistula is a small channel or tube like passageway between two or more body parts that are usually not connected.
What is Anal Fistula?
An Anal Fistula is a defective tunnel like connection between anal canal (internal opening) and the perianal skin (external opening). Anal abscess is an infected cavity filled with pus, around the rectum and anus. The tract formed below the abscess is the fistula. A fistula is formed because the abscess is not drained completely. Abscesses can recur if the Fistula seals over, allowing the accumulation of pus. It then points to the surface again and the process repeats.
What are the symptoms of Anal Fistula?
Pain is the most common symptom. It could be mild or throbbing, while sitting or opening the bowel.
Swelling, redness of skin and skin irritation around the anus
Irritation due to pus or blood discharge
Recurrent abscess formation
In rare cases fever.
How Anal Fistula is diagnosed?
Detecting the external opening of an Anal Fistula is usually easy through the diagnosis, while finding the internal opening can be challenging. Knowing the fistula's complete tract is critical for effective treatment.
Doctors use Fistula Probe to find the tract. It is a specially designed instrument that can be inserted into Fistula.
Digital Rectal Exam is one of the common way.In rare cases, other procedures used are –
Diluted methylene blue dye: Injected into a fistula
Fistulography: Injection of a contrast solution into a fistula and then X-raying it
Magnetic resonance imaging (MRI)
Flexible sigmoidoscopy: A thin, flexible tube with a lighted camera inside the tip allows doctors to view the lining of the rectum and sigmoid colon as a magnified image on a television screen
What are the Types of Fistula?
Gastrointestinal fistula: These Types of Fistula have abnormal openings in the stomach and intestines that cause the contents to leak out into the body. These Types of fistulas are the results of surgery or from inflammatory bowel disease such as Crohn's disease or ulcerative colitis. Sometimes they may not have symptoms, but symptoms that could be present may include leakage from the contents of the intestine through the openings of the skin. .
Anal fistula: - An anal fistula is the result of an inflammatory tract between the anal canal and the skin. They begin in the anal crypts, which can become infected with abscess formation. If the abscess opens or ruptures, then it becomes a fistula. Symptoms may include itching, discharge or watery pus, rectal pain or an irritation of the skin around the anus.
Urinary fistula: - A urinary fistula is a Type of Fistula that has an abnormal opening in the urinary tract organs or an abnormal connection between the organs. There may be an opening in the bladder or problems with the colon. They might be caused from injuries during a surgery or trauma. Most often they are results of surgery of the bladder or pelvis. Symptoms may include leakage from the vagina, vulva irritation or many urinary tract infections
Arteriovenous fistula: - Individuals can be born with an arteriovenous fistula, but that is uncommon. Instead of blood flowing from the arteries into the capillaries and then to the veins, the blood flows from the artery directly into the vein without going into the capillaries at all. This Type of Fistula can occur if a person is stabbed with a knife or has been shot. It can develop quickly, or take some time. Symptoms may include a mass that can be felt, and the area may be swollen and warm to the touch.
Perilymph fistula: - This Type of Fistula happens when there is an abnormal connection in the air-filled middle ear and the fluid-filled inner ear. There may be an opening between those two areas where there could be complications in parts of the ear, such as the membranes called the round window and the oval window. Or there could be complications in the bone part of the ear which is called the otic capsule. Some of the symptoms of a perilymph fistula may include dizziness, hearing loss, sensitivity to pressure and sensitivity to loud noises.
What are the surgical options availale?
Surgery is the only cure for Fistula. However, choosing the right surgery is very important. The goal of a surgery is to repair the anal fistula completely, prevent recurrence and to protect anal sphincter. Depending on the location and complexity of the fistula the surgery can be decided.
Fistulotomy - One of the common procedures used in more than 80% of cases. This surgery unroofing over the whole length of the fistula in order for the surgeon to flush out the contents.
Seton technique - A seton is a string of silk or latex which is left into the fistula tract to drain out infection. This may be considered if you are at high risk of developing incontinence when the fistula crosses the sphincter muscles. This procedures require many sittings.
Advancement flap procedure- This procedure is used when there is a high risk incontinence. In this procedure a piece of tissue (flap) is removed from the rectum or from the skin around the anus. During surgery, the fistula tract is removed and the flap is reattached where the opening of the fistula was.
Fibrin glue- The only non-surgical treatment option available. Special formulated glue is injected into the fistula to seal the tract, then the opening is stitched closed. It is a simple, safe and painless procedure, but long term results for this method are poor and patient may require another sittings.
Video Assisted Anal Fistula Treatment (VAAFT) - This is one of the latest and improved surgical technique for simple and complex anal fistulas. In this procedure a fistuloscope called Karl video equipment is used to view the fistula tract. Once the internal opening is identified, it is stitched and the fitsula is removed using electric current and the external opening is shut using fibrin glue. This procedure is painless with very low risk of incontinence and the chances of recurrence are also less.
The most crucial thing is to maintain anal hygiene, toilet hygiene, having sex with protection, avoiding spicy food and excessive sedatives and pain killers.
What are the chances of recurrence?
Despite proper treatment and apparent complete healing, fistulas can potentially recur, with recurrence rates dependent upon the particular surgical technique utilized. With the conventional surgery method, the chances of recurrence after surgery are as high as 20% even in simple fistulas largely because of a failure to identify these secondary tracks and the site of the internal opening.
Travel to India for Fistula Surgery:
Several superspeciality hospitals in India offer comprehensive Urological services to diagnose and treat stone disease, urological cancer, incontinence, infertility, impotency and other urinary difficulties. Advanced methods such as lithotripsy for treating kidney and ureteric stones without surgery are available with complementary methods of treating stones endoscopically. Advanced machines like the Lithostar obvert the need for anaesthesia in the treatment of kidney and ureteric stones. High tech facilities for the treatment of prostate, bladder cancers, urethral strictures are also available. Investigation and treatment facilities for impotence and male/female infertility exist with specialised facilities for pharmacotherapy, cavernosometry and cavernosography, in addition to doppler studies for the assessment of blood flow.
India is considered the leading country promoting medical tourism-and now it is moving into a new area of "medical outsourcing," where subcontractors provide services to the overburdened medical care systems in western countries. Western patients usually get a package deal that includes flights; transfers, hotels, treatment and often a post-operative vacation, the reasons patients travel for treatments vary. Many medical tourists from the United States are seeking treatment at a quarter or sometimes even a 10th of the cost at home. From Canada, it is often people who are frustrated by long waiting times. From Great Britain, the patient can't wait for treatment but also can't afford to see a physician in private practice. For others, becoming a medical tourist is a chance to combine a tropical vacation with surgery.
Frequently Asked Questions About Fistula Surgery India
Will I have any pain?
-You will feel pain for the first couple of days, but the pain will ease over the time.
What should I expect when I go to the toilet?
-You will feel little discomfort and probably little bleeding while opening the bowel. Your urosurgeon may prescribe some pain killers that you can take about 15-20 minutes before to minimize the pain.
When can I return to work and normal activities?
-Almost all the procedures are day care procedures, however, you might be required to take a few days off depending upon the surgery. It may vary from 3-5 days.