Surgery for Anal Fistula Treatment

What is an anal fistula?

An abnormal connection between the lining on the inside of your anal canal (back passage) and the skin near your anus is called An Anal Fistula. Most of the anal fistulas are caused by an abscess (a collection of pus) which has developed in your anal canal. The pus can drain away onto the skin on its own or by a Surgery. A fistula occurs when the track, made by the pus on the way to the surface of the skin, stays open. Surgery is usually essential to treat an anal fistula as very few heal by themselves.

The best option for you will depend on:

• The position of your fistula.
• Whether it is a single channel or branches off in different directions.

Sometimes it is needed to have an initial examination of the area under general anesthetic (where you're asleep) to help determine the best treatment. Your surgeon will tell you about the options available and which one they feel is the most suitable for you. Usually, surgery for an anal fistula is carried out under general anesthetic. In many cases, it's not required to stay in the hospital overnight afterward. The main objective of surgery is to heal the fistula while avoiding damage to the sphincter muscles, the ring of muscles that open and close the anus, which could potentially result in loss of bowel control bowel incontinence.

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Symptoms leading to laser treatment for Fistula

An anal fistula is a channel that links the skin in the anal region to the inner lining of the rectum. It commonly evolves after a tumor which is an infection in the anal gland. However, if ignored it causes complications though there are treatments available through the help of a doctor.

Here are the common symptoms of an anal fistula: 

• Persistent Anal Discharge
• Pain and Discomfort
• Swelling or Redness
• Itching or Irritation
• Recurrent Abscesses
• Bleeding
• Fever and Malaise

What are the Risks involved in anal fistula surgery?

Like any type of medical treatment, treatment for anal fistulas also carries a number of risks.

The main risks in anal fistula surgery are:

• Infection – Anal fistula surgery may require a course of antibiotics; severe cases may need to be treated in hospital.
• Recurrence of the fistula – Sometimes, the fistula can recur despite surgery.
• Bowel incontinence – This is a potential risk with most types of anal fistula treatment, although severe incontinence is rare and all possible efforts will be made to prevent it.

The level of risk will depend on things like what is the location of your fistula and the specific procedure you have. Speak to your doctor about the potential risks of the procedure they recommend.

Causes leading to laser treatment for Fistula

The predisposing factors of anal fistulas mainly relate to infections, but may be associated with other causes.

Here are the common causes:

• Anal Abscess
• Inflammatory Bowel Disease
• Trauma or Injury
• Infections
• Cancer
• Radiation Therapy
• Chronic Diarrhea or Constipation
• Genetic Factors
• Immunocompromised Conditions

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Facilities and Services offered for International Patients for Fistula Laser Surgery

The surgical procedures for anal fistula in hospitals and medical centres that attend to international patients may involve a combination of services that seek to address the medical, administrative and personal issues of patients seeking for the procedures.

Here are the typical facilities and services available for international patients:

• Pre-Surgery Consultation and Diagnosis
• Surgical Treatment Options
• Post-Surgery Care
• Language and Communication Services
• Travel and Visa Assistance
• Accommodation Services
• Cost Transparency
• Rehabilitation and Post-Discharge Support

Pre-Treatment Process of Fistula Laser Surgery

Preoperative preparations for the patient with an anal fistula include several critical operations to evaluate the patient’s condition, diagnosis the type of fistula, and plan further treatment actions.

Here’s an overview of the typical pre-treatment process:

• Initial Consultation
• Diagnostic Tests
• Assessing for Underlying Conditions
• Treatment Plan Discussion
• Pre-Surgery Preparation

Diagnostic Tests for Fistulectomy Surgery

Thus before an individual has to undergo surgery for an anal fistula, the physician does carry out several tests to try and determine the structure, the position of the fistula and its complexity in the least invasive way possible. These tests enable the surgeon to determine the right approach for the operation and avoid other related problems.

Here are the key diagnostic tests typically used:

• Physical Examination
• Anoscopy/ Proctoscopy
• Endoanal Ultrasound
• MRI
• Fistulogram
• Endorectal Ultrasound
• Stool Culture and Infection Testing
• Blood Tests
• Rectal Manometry

Fistulectomy Surgery 

Fistulotomy

• Fistulotomy is the most common type of surgery for anal fistulas. 
• This procedure involves cutting along the whole length of the fistula to open it up so it heals as a flat scar. 
• A fistulotomy is the most effective treatment for many types of anal fistulas, although it's usually only suitable for fistulas that don't pass through much of the sphincter muscles, as the risk of incontinence is lowest in this type of cases.
• If your doctor has to cut a small portion of anal sphincter muscle during the surgery, they will make every attempt to reduce the risk of incontinence.
• If the risk of incontinence is considered too high, one of the procedures below may be recommended instead.

Seton techniques

• If your fistula passes through a significant portion of the anal sphincter muscle, your doctor may initially recommend inserting a Seton.
• A Seton is a piece of surgical thread that is left in the fistula for some weeks to keep it open. 
• This allows it to drain and helps it heal while reducing the need to cut the sphincter muscles.
• Loose Setons allow fistulas to drain, but they don't cure them. 
• Tighter Setons may be used to cut through the fistula slowly to cure a fistula. 
• This may require several techniques that your surgeon can discuss with you.
• Alternatively, they may suggest carrying out several fistulotomy procedures, carefully opening up a tiny section of the fistula each time or one of the treatments described below. 

Advancement flap procedure

• Your surgeon may suggest you an advancement flap procedure if your fistula passes through the anal sphincter muscles and having a fistulotomy carries a high risk of causing incontinence.
• This procedure involves cutting or scraping out the fistula and covering the hole where it entered the bowel with a flap of tissue taken from inside the rectum, which is the final part of the bowel.
• The Success rate of advancement flap procedure is lower than a fistulotomy but avoids the need to cut the anal sphincter muscles.

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Bioprosthetic plug

• Another procedure in cases where a fistulotomy carries a high risk of incontinence is the insertion of a bioprosthetic plug.
• A Bioprosthetic plug is a cone-shaped plug made from animal tissue that is used to block the internal opening of the fistula.
• Some studies on this have suggested that this may be an effective treatment for anal fistulas, but more evidence is needed to be certain.
• The National Institute for Health and Care Excellence (NICE) currently recommends carrying out the technique as part of medical research.

LIFT procedure

• The ligation of the intersphincteric fistula tract (LIFT) procedure is the latest treatment for anal fistulas.
• It's designed as a treatment for a type of fistulas that pass through the anal sphincter muscles, where a fistulotomy would be too risky.
• During the procedure, a cut (incision) is made in the skin above the fistula and the sphincter muscles are moved apart. 
• The fistula is then sealed at both of the ends and cut open so it lies flat.
• This technique has had some promising results so far, but it's only been around for a few years, so more research is needed to determine how well it works in the short and long term.

Fibrin glue

• Treatment with fibrin glue is currently the only option which doesn’t include surgery for anal fistulas.
• It involves your surgeon injecting special glue into your fistula while you've given a general anaesthetic. 
• The glue helps seal the fistula and also helps it heal.
• Generally, it’s less effective than fistulotomy for simple fistulas and the results may not be long-lasting, but it may be a useful option for fistulas that pass through the anal sphincter muscles because they do not need to be cut.

Post-Treatment Process of Laser Operation for Fistula

Following postoperative management plays an essential role in the post-treatment aspect for an anal fistula. As is cause to expect, recovery process may be different depending on the character of the fistula and the kind of surgery that was made.

Here’s an overview of the typical post-treatment process:

• Immediate Post-Surgery Care
• Wound Care
• Diet and Bowel Movements
• Pain and Swelling Management
• Follow-up Appointments
• Managing Possible Complications

Success Rate of Laser Operation for Fistula 

The overall success rate for anal fistula surgery for all types of fistulas is 70 – 90% and if, therefore, includes more complex or recurrent fistulas and basic or simple low fistulas treated with simple surgical procedures.

Best Hospitals for Fistula Laser Operation

• Artemis Hospital, Gurgaon
• Medanta The Medicity, Gurgaon
• Max Hospital, Saket
• BLK-Max Super Speciality Hospital, New Delhi

Anal Fistula Specialists

• Dr. M.A Mir
• Dr. Amanjeet Singh
• Dr. Atul N.C Peters
• Dr. Rajan Madan

Why Choose GetWellGo for Anal Fistula Laser Treatment?

GetWellGo is a healthcare service provider that may have specialized facilities and services to cater for patients who require surgery for anal fistula. Many possibilities are granted by the selection of some healthcare provider as GetWellGo, especially if this provider has positive precedents for intensive care and patient-oriented work.

Here are some reasons why you might consider GetWellGo for anal fistula surgery:

• Expertise in Specialized Surgical Care
• Comprehensive Diagnostic Services
• Minimally Invasive Treatment Options
• Post-Surgery Care and Follow-up
• Focus on Healing and Recovery
• Cost-Effective Treatment
• Language Support
• Travel and Accommodation Services
• Visa Assistance

Conclusion

There is no internal medication that can cure an anal fistula, but surgery is the best cure and comes with great benefits. For several reasons including complexity of the fistula, its location, general health of the patient and conditions such as Crohn’s disease, the type of surgery to be performed is determined. The current principal surgical management techniques are fistulotomy, Seton insertion, flap surgery, LIFT procedure, laser treatment and fibrin glue. The success often differs depending on the type of fistula the patient has, and for simple fistulas, success is higher. Recovery is really a self-explanatory term since patients undergo pain control, dressing of the wound, and physical modifications to their lifestyles. Some of the possible associated risks are incontinence, recurrence and related infection. Despite the fact that the individual centers provide the plans and concentrate on the total client, the approach may be more beneficial to the patients in the long run.

FAQ

1. What are the advantages of an operation for an anal fistula?

• Complete Healing: Surgery has the advantage of allowing for a definitive treatment by excision or obliteration of the fistula tract.
• Symptom Relief: Some advantages of surgery are reduction of pain, swelling and discharge that are characteristic of fistula.
• Improved Quality of Life: Patients who undergo tracheostomy surgery get a considerably better level of comfort and condition after healing.
• Prevention of Recurrence: The possibility of recurrence is reduced by correct surgical approach and although this has better outcomes with primary fistulas.

2. What is the success rate of anal fistula surgery?

• For primary alleviate of simple anal fistulas, it is estimated to achieve success rate that range from 70-95%.
• In terms of several or repetitive anal fistulas, simple primary surgery gets about 60-80% but better can be achieved using additional approaches like seton placement or flap surgery.
• Laser surgery as well as LIFT procedures has been known to be 70 to 90% effective depending on the difficulty of the procedure.

3. How long does it take to recover after anal fistula surgery?

• Initial Recovery: Patients sometimes take about two to six weeks to heal in the first instance following the treatment.
• Full Recovery: It may also take 2-6 months to achieve total healing with fistula, including the final closure.
• Return to Normal Activities: majority of the patients recovers within weeks but some tasks should not be taken up for several months including strenuous activities such as lifting.

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