Treatment of anal fistulas

Treatment of anal fistula. Anal fistula can be healed only by operation. 

Operation about anal fissure requires good knowledge of anatomy, physiology and big clinical experience, that’s why patients with anal fissure should be operated only in proctology department by proctologist (that is very important to safe anal sphincter).

If anal fissure is escalated and patient has anorectal abscess it should be adequately drained. In this case, anal fistula can be operated only after elimination the signs of inflammation. Long term between abscess drainage and radical operation is not rational, because in this period abscess can occur again and risk of anal sphincter distraction will be much higher. If infiltrates along anal fissure exist, previously, should be applied anti-inflammation therapy (antibiotics, physiotherapy) and only after that can be carried out radical operation. In case if, this process is chronic and there are no symptoms of escalation target operation should be performed. In period of consistent remission, (if external opening was scared) operation should be delayed because in this period surgeon can not see any clear-cut marks for radical operation. In this case, operation can be ineffective and even dangerous since uninjured tissue can be hurt. And then operation can be performed when external opening again opens.

Method of operation is defined by several factors:

• localization of anal fistula relatively to anal sphincter,
• expression of scar in region of internal opening and rectal wall,
• existence of abscesses or infiltrates in perianal fat.

The most popular methods of operation in case of anal fistula:

• Cutting of anal fistula into rectum
• Excision of anal fistula into rectum
• Excision of anal fistula into rectum with cutting and draining of abscesses
• Excision of anal fistula into rectum with sphincter reconstruction
• Cutting seton operation
• Excision of anal fistula with mucosal flap advancement technique
• Treatment of anal fistula with plug technique – Surgisis® Biodesign™ Fistula Plug

Outcomes

Outcomes of surgical treatment of intershincteric and low trans-sphincteric fistulas are satisfactory (complete recovery without any series complication). High fistulas (high trans-sphincteric and іuprasphincteric) can be recovered also without any functional disorders. Results of surgical treatment of recurrent fistulas with long-term inflammation, abscesses, manifest scar in rectal wall and sphincter are much worse. That’s why operation should be performed on time and professionally (one of the most important rule in fistula’s therapy).

Our clinic has unique huge experience of anal fistula treatment. The first time in Ukraine, we include Endorectal ultrasound examination in diagnostic algorithm of patients with anal fistula. We studied immune status of patients and identified indications for reconstructive operations. In 2009 year the first time in Ukraine, we performed innovative method of anal fistula treatment, which is based on using.