A fistula is an abnormal connection between two parts, which occurs inside the body. Symptoms can range from mild itching or stinging to severe acute pain, and even bleeding or pus. Surgery is the most effective treatment for patients who suffer from it.
An anal fistula is a tract that communicates the anal canal with the skin. It is usually caused by infection of glands located in the so-called “dentate line”, which is the area where the rectum ends and the anal canal begins.
In most cases the infection is spontaneous or idiopathic, although sometimes it is associated with inflammatory bowel diseases such as Crohn’s disease.
The acute form of infection is anal abscess, which is usually controlled with antibiotics or surgical debridement. 50-70 % of cases subsequently progress to the development of a fistula.
Patients usually undergo surgery for anal fistula. There are only a few exceptional cases that resolve spontaneously and do not require surgical intervention. However, when the fistula is already established, the only curative treatment is surgery.
Simple or complex fistulas
There are different ways to treat each type of fistula. Depending on whether the path of the fistula crosses or affects more or less the anal sphincteric musculature (consisting of the internal and external anal sphincter), fistulas are classified as simple or complex, which determines the surgical technique to be used.
In the case of simple fistulas, which affect the sphincters less, the technique most commonly used and with the best long-term healing results is the “lay-flat” technique, which consists of opening the tissue through which the fistula passes like a book, so that it can subsequently heal. More recently, the “lift” technique has been developed, which barely sections muscle fibers.
Complex fistulas, which would include deeper tracts involving a lot of sphincteric musculature, recurrent fistulas (previously operated) or those associated with other intestinal diseases, require the application of other techniques, also of greater complexity, in order to preserve the sphincteric musculature and its function, to avoid possible postoperative incontinence.
Therapeutic options must also be taken into account. These range from the so-called “rectal advancement flap” (a kind of plasty with the rectal mucosa), the use of biological glues, patches of healing substances (Surgisis) and even the most recent use of the laser period (FILAC: Fistula-tract Laser Closure).
Postoperative period
Depending on the technique used there may be some more specific rules, but in general all that is required is to follow a relative rest the first postoperative days, with painkillers if necessary and good hygiene of the anal area, recommending in some cases the application of ointments to promote wound healing.