Overview:
- Perianal fistula is an abnormal connection between anal canal and skin which causes anal itching, discomfort and discharge continuously
- Perianal fistula is classified according to its position relative to the external anal sphincter into:
- Intrasphincteric fistula: between the inner and outer sphincter
- transsphincteric fistula
- suprasphincteric fistula
- extrasphincteric fistula
Etiology:
When one of anal glands in anal canal blocked, it becomes inflamed and forms a small abscess in the anal wall
abscess can be cured by draining it spontaneously into the anal canal or by taking antibiotics
and it can open on the skin leading to the formation of fistula
Symptoms:
- Anal itching
- Skin irritation
- Discomfort
- Pain while defecation
- purulent discharge
- recurrent abscesses
Causes:
- Inflammation of glands in the anal canal
- Crohn’s disease
- Tuberculosis
- Sexually transmitted diseases
Diagnosis:
- clinical examination with anoscope to investigate the inner orifice
- colonoscopy in complex fistulas
- MRI or endoscopic ultrasound to investigate the fistula tract in preparation for surgery to choose an appropriate technique
Treatment:
fistulectomy:
all fistula tract is totally removed
fistulotomy:
lay open fistula tract and left to heal
Closing the fistula by LASER ablation:
fistula tract is probed
internal orifice of the fistula is closed
fistula tract is closed through the LASER ablation
Closure of the fistula with the assistance of video VAAFT:
Fistula tract is probed with a rigid scope,
internal orifice of the fistula is closed
fistula tract is closed through the LASER ablation under a complete tract detection with scope
SETON placement and mucosal closure:
In complex cases
seton (or sutures) is placed through fistula tract and tied
seton remains for several weeks to avoid any collection or abscesses
the fistula is closed later with a rectal mucosa flap.
