There are many procedures to treat fistulas. Depending on particular case and severity it is, the surgeon, and even the country you live in, will determine which procedure may be recommended to you.
Fistula treatment is a challenge for modern medical science. Antibiotics & advance surgeries can not assure the removal of fistula track & infection. So there are many techniques developed to operate fistula. Some of them are described here.
Excision (removal) of the fistula track & then allowing it to heal by granulation.
Cutting seton :
If the fistula is in a high position and it passes through a significant portion of the sphincter muscle, a cutting seton may be used. This involves inserting a thin tube through the fistula tract and tying the ends together outside of the body. The seton is tightened over time, gradually cutting through the sphincter muscle and healing as it goes. Once the fistula tract is in a low enough position it may be cut open to speed up the process or the seton is kept in place until the fistula is completely cured and the seton eventually falls out.
Fibrin glue injection :
This is a method explored in recent years, with variable success. It involves injecting the fistula with a biodegradable glue which should, in theory, close the fistula from the inside out, and let it heal naturally.
Fistula plug :
This surgery involves plugging the fistula with a device made from small intestinal submucosa. The fistula plug is positioned from the inside of the anus with suture.
Advancement flap surgery :
This is a procedure in which the internal opening of the fistula is identified and a flap of mucosal tissue is cut around the opening. The flap is lifted to expose the fistula which is then cleaned and the internal opening is sewn shut. After cutting the end of the flap the flap is pulled down over the sewn internal opening and sutured in place. The external opening is cleaned and sutured.
LIFT Technique :
LIFT (ligation of inter sphincteric fistula tract) procedure is based on secure closure of the internal opening and removal of infected cryptoglandular tissue through the inter-sphincteric approach. Steps of the procedure include – incision at the intersphincteric groove, identification of the inter-sphincteric tract, ligation of intersphincteric tract close to the internal opening and removal of intersphincteric tract, scraping out all granulation tissue in the rest of the fistulous tract, and suturing of the defect at the external sphincter muscle.
Video Assisted Anal Fistula Treatment (V.A.A.F.T.) :
This is technologically the latest surgical treatment available for Fistula-in-ano. Under anaesthesia, a small telescope is passed through the outer opening of the fistula-in-ano on the skin. This is connected to an HD-camera which transmits the image of the inner side of the fistula tract to an HD- monitor. Under vision, the whole length of the fistula tract is removed up to its internal opening which is present inside the anal canal on its wall. Any branching of the fistula tracts can also be identified and treated by this method. The internal opening is then closed using a stitch or a stapler so that stools / feces do not leak back again into the fistula tunnel. Daily dressing is gently done by just flushing with saline using a syringe to remove the dead tissue inside the healing fistula tract.
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