Treatment of anal fistula
The only available treatment for anal fistula is surgical. Treatment with antibiotics has temporary results and the problem may recur in a more extensive way. A preoperative mapping of anal fistula with endoanal ultrasound contributes to a better understanding of fistula’s anatomy.
The best treatment for simple low fistulas is lay-open. That is the tissue covering fistula is divided and the fistula tract comes to the surface (simple fistulotomy). The secondary healing of the wound is easy and pain is minimal.
- Complications of surgery
If the ramifications or the anal opening are not treated, fistulas reappear.
If a significant part of anal sphincter is divided, fecal incontinence may be a major complication of fistulotomy.
In the case that anal fistula runs through a significant part of anal sphincter, then they are labelled as high or intersphincteric anal fistula.
Specialized surgical techniques for treatment of high anal fistulas.
The successful treatment of high anal fistulas require special surgical techniques because sphincter damage and fecal incontinence may result from the simple lay-open technique in this category of anal fistulas.
The best known techniques for the management of anal fistulas are the following
- Staged division of anal sphincter (staged fistulotomy)
- Insertion of a loop through anal fistula for drainage of the pus (loose seton technique0
- Tightening of the seton loop for preservation of anal sphincter function (tight seton technique)
- Insertion of collagen plug into the anal fistula (anal fistula plug)
- Collagen plug insertion into fistula tract (anal fistula plug).
- Closure of anal opening and reinforcement with a mucosal flap.
- Mesosphincteric ligation of fistula tract (LIFT procedure)
- Closure of anal opening with OTSC proctology clip.
- Closure of anal opening and cauterization of fistula tract with laser (FiLaC®).
In our settings, we perform only techniques that have been approved in the National Health Systems of UK, USA or France.
PROCTOLOGY CLINIC- ATHENS GREECE
