Anal Fistula Surgery

Anal fistula surgery is a surgical procedure performed for the removal of a fistula that has been formed in the anus region.
An anal fistula is a small tunnel connecting an infected cavity or abscess in the anus to an opening on the skin surrounding the anus.
The anus is an external opening through which feces is eliminated from the body. There are several small glands inside the anus that make mucus. These glands could sometimes get clogged and infected, causing an abscess formation. Some of these abscesses may develop into a fistula.

The causes of anal fistula include:

• Trauma
• Radiation therapy (treatment for cancer)
• Crohn’s disease (inflammatory intestinal disease)
• Sexually transmitted diseases
• Cancer
• Tuberculosis (a bacterial infection that primarily affects the lungs) 
• Diverticulitis (a condition in which small pouches are formed in the large intestine and get inflamed)

Symptoms

An anal fistula may have the following symptoms:

1. Pain around the anus
2. Swelling
3. Frequent anal abscesses
4. Bleeding
5. Irritation of the skin around the anus
6. Pus drainage from an opening around the anus
7. Pain during bowel movements
8. Fever
9. Chills
10. Fatigue

Diagnosis

1. Physical examination: The doctor will check for a fistula opening near the anus and press on the area to check for pus drainage and soreness. The patient’s symptoms and medical history are noted.
2. Fistula probe examination: A long and thin probe is inserted through the outer opening of the fistula. A special dye is then injected to find the fistula opening inside the body.
3. Anoscopy: A special instrument, called an anoscope, is used by the doctor to view inside the anus and the rectum.
4. Blood tests: Certain medical disorders can be detected with the help of blood tests.
5. Imaging studies: Imaging studies like MRI scans and ultrasounds may be used to obtain clear pictures of the anal region.

Treatment

Simple anal fistulas usually heal by using certain medications and self-care. Complex anal fistulas may need surgical treatment as medications alone fail to treat them.
Anal fistula treatment can be done surgically and non-surgically in the following ways:
 

1. Non-surgical treatment:

The different non-surgical forms of treatment include: 

Medications:

The doctor may recommend certain medications like antibiotics. Medications and self-care are however normally not sufficient to treat anal fistulas alone.

Fibrin glue:
A fibrin glue is injected by the surgeon into the anal fistula. This glue helps to seal the fistula and allows its healing.

2. Surgical treatment:

The anal fistula surgery is generally performed under general anesthesia, that is, the patient is put to sleep during the procedure. The different types of surgeries that can be performed to treat anal fistulas include:

Fistulotomy:
It is the most effective and common type of anal fistula surgery.
Anal fistulas having little or no involvement with the sphincter muscle (muscle ring present at the bottom of the anus) are treated by this procedure.
The surgeon will first cut open the skin and muscles over the tunnel. This creates an open groove, that can heal from the bottom upwards.

Seton techniques:
If the anal fistula passes through a big part of the sphincter muscle, the surgeon could insert a seton.
A seton is a type of surgical thread, that is left in the fistula for several weeks to keep it open.
This aids in drainage and healing without having to cut the sphincter muscles.

Advancement flap procedure:
When the fistula passes through the anal sphincter muscles and fistulotomy poses a high risk of developing incontinence, this procedure is performed.
The fistula will be scraped out by the surgeon and the hole where the fistula entered the bowel is covered using a flap tissue from inside the rectum (the final portion of the bowel).

LIFT procedure:
The ligation of the intersphincteric fistula tract or LIFT procedure is performed when the anal fistula passes through the sphincter muscles, and fistulotomy is very risky.
The surgeon makes a cut in the skin above the fistula and moves apart the sphincter muscles.
The anal fistula will then be tied off.

Endoscopic ablation:
An endoscope (a tube with a camera on one end) is placed by the surgeon in the fistula.
An electrode will then be passed through the endoscope to seal the fistula.

Laser treatment for Anal Fistula Surgery:
A small laser beam is used to seal the fistula in this procedure.

Bioprosthetic plug:
It is a cone-shaped plug made up of animal tissue.
This plug is inserted by the surgeon into the anal fistula to block its internal opening.

Risks

Anal fistula surgery may have the following complications:

• Infection
• Bleeding 
• Adverse effects to the anesthesia used
• Loss of control over bowel movements
• Delayed wound healing 
• Fistula recurrence
• Pain 
• Swelling
• Fever
• Chills
• Redness 
• Scarring
• Diarrhea
• Constipation 
• Flatulence 
• Discharge from the anus
• Anal canal narrowing causing difficulty in having bowel movements
• Difficulty in passing urine

After Procedure

• The patient normally goes home on the same day or the day after the surgery.
• The doctor may recommend painkillers and antibiotic medications to relieve the patient's discomfort and reduce the risk of infection.
• The wound dressing should be regularly changed. 
• The patient needs to wear a gauze pad over the anal area till complete healing takes place. This is done so as to prevent the discharge from leaking onto the clothes.
• The patient needs to avoid having sexual intercourse for a few weeks post-surgery.
• The patient should exercise gently to prevent any irritation to the unhealed wound.
• The patient can resume his/her daily activities after the surgeon permits the same.

Home remedies:

• The patient should soak in warm water, three or four times a day, to keep the wound clean and then pat dry it gently.
• The patient can use a laxative or stool softener, in case of constipation, for easy bowel movements.
• The patient can use a pillow or rolled-up towel while sitting down.
• The doctor may prescribe certain ointments for pain relief.
• The patient should eat a high-fiber diet.
• Spicy foods should be avoided.
• The patient should drink plenty of liquids throughout the day.
• Maintain personal hygiene and use water to clean your anal region gently instead of using tissue paper.

Cost of Anal Fistula Surgery in India

The cost of anal fistula surgery in Mumbai is between INR 50,000 to INR 75,000.

The cost of anal fistula surgery in Bangalore is between INR 45,000 to INR 60,000.

The cost of anal fistula surgery in Delhi is between INR 45,000 to INR 60,000.

The cost of anal fistula surgery in Chennai is between INR 40,000 to INR 55,000.