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Surgical Remedies for Anal Fistula

An anal fistula does not usually heal independently. Surgery is generally required to treat it. The procedure depends on the location of the fistula and whether it is a single tube or bifurcates in different directions. 

An initial assessment of the area under general anesthesia may be required to determine the best treatment. The surgeon will inform you the available options and which one is suitable for you. Anal fistula surgery is usually under general anesthesia.

In most cases, extended hospitalization is not necessary. Surgery aims to heal the fistula while avoiding damage to the sphincter. Damage to the sphincter can lead to loss of defecation control (defecation incontinence). 

The standard remedies are listed below;

A Fistulotomy

This treatment is the most common surgery for anal fistula.

The fistula is cut over its entire length to open and heal as a flat scar. It is the most effective procedure for many anal fistulas. It has the lowest risk of incontinence and is usually suitable for fistulas that do not pass through the sphincter. 

If the surgeon has to cut a small portion of the anal sphincter during surgery, he will do everything possible to reduce the risk of incontinence. However, doctors may recommend another procedure if the risk of incontinence is high. 

The seton techniques

If the fistula passes through a large portion of the anal sphincter, the surgeon may recommend inserting a seton first. A seton is a surgical thread left behind in the fistula for several weeks to keep the fistula open. 

This process eliminates the need to cut the sphincter, allows for drainage, and helps to heal. Loose setons drain fistulas but do not heal them. So to remedy the anal fistula, the doctors will use a tighter seton to cut the fistula slowly. This process may require steps that the surgeon will discuss with you. 

Alternatively, multiple fistulotomies are also an option, or doctors may suggest other treatments where they open a small portion of the fistula in a series of procedures. 

An advanced flap procedure

Prior flap surgery can be an option if the fistula passes through the anal sphincter and there is a high risk of fistulotomy causing incontinence. This process involves cutting or scraping the fistula and covering the hole that enters the intestine. Then, the doctors cover it with a flap of tissue taken from the rectum, the last part of the intestine.

This procedure is less successful than a fistulotomy but eliminates the need to remove the anal sphincter.

The LIFT technique

Intersphincter fistula ligation (LIFT) is a treatment for fistulas that pass through the anal sphincter, where the risk of fistulotomy is too high. Treatment involves cutting the skin above the anal fistula and releasing the sphincter. The fistula is then closed at both ends and opened up flat. 

This procedure has had some promising results, but it is a relatively new technique. More research is necessary to determine its advantages in the short and long term. 

An endoscopic ablation

In this procedure, the doctors insert an endoscope (a tube with a camera at the end) into the fistula. The electrodes are then passed through the endoscope and used to close the fistula. Endoscopic ablation works well and there are no serious concerns about its safety. 

Using fibrin glue

Treatment with fibrin glue is currently the only non-surgical option for anal fistula. The surgeon injects surgical glue into the fistula while you are under general anesthesia. The surgical glue seals the fistula and helps promote its healing. In general, a simple fistula is less effective than a fistulotomy, and the results may not be permanent. Still, a fistula that passes through the anal sphincter does not need to be cut, making it a practical option. Treatment with fibrin glue is currently the only non-surgical option for anal fistula.

Bioprosthetic plug

Another option is to insert a bioprosthesis plug. It is a conical plug made of animal tissue to close the fistula’s internal opening. This procedure effectively blocks anal fistulas, and there are no serious concerns about its safety.

Risks involved in this surgery

The main risks are: 

Infection-It may require the administration of antibiotics. In severe cases, professional treatment may be necessary.

Fistula Relapse – Fistula may recur despite surgery

Defecation incontinence-Severe incontinence is rare, and doctors make every effort to prevent it, but this is a potential risk in treating most types of anal fistula.

Conclusion

The level of risk depends on where the fistula is and the specific procedure. Talk to your surgeon about the potential dangers of the techniques they recommend.

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