Anal fistulas can cause great pain and discomfort, and almost always require surgery. They are usually the result of an infected gland, and if left untreated, are likely to worsen and produce further abscesses.
What is an anal fistula?
Anal fistula is the medical term for an infected tunnel that develops between the end of the bowel and the skin at the anus.
Symptoms include itching, pain, redness and swelling around the anus. In addition, a patient may experience a foul-smelling pus discharge or bleeding in that area.
90% of anal fistulas are the result of an infected anal gland.
Just inside the anus are a few small glands that make mucus. Occasionally, these glands get clogged and become infected, causing a pocket of pus (abscess). If the abscess is left untreated, it can grow and make its way to the surface skin so that the pus can drain. The fistula is that tunnel that connects the infected gland to the anus.
Other, much less common causes of anal fistulas include Crohn’s disease, STDs, tuberculosis, diverticulitis, ulcerative colitis, and cancer.
There’s no medication to fix this disorder, so surgery is used. Various surgical methods can be used depending on the size, location and complexity of the fistula. These procedures are usually done on an outpatient basis, so patients can return home the same day of the operation.
For a simple fistula that is shallow and not too close to the sphincter muscle, a fistulotomy is the most common procedure. The surgeon cuts open the whole length of the fistula so it can heal from the inside out. Fistulotomies enjoy a very high 90% success rate.
Other surgical procedures include fistulectomy, where the fistula is extracted completely. A fistulectomy can be used on both simple and complex fistulas, but its far less frequently performed due to its radical nature.
Prior to surgery, a seton (surgical thread) may be placed in the fistula for several weeks to help it drain and heal.
Advancement flaps, plugs and glues are other techniques with varying degrees of success.
Laser treatment for anal fistulas
Medical laser technology is steadily progressing, and it is increasingly being used for treating anal fistulas.
FiLaC® (Fistula-tract Laser Closure) laser therapy is a minimally invasive technique with a success rate of up to 80%.
This state-of-the-art procedure involves the insertion of a flexible laser fibre in the path previously marked by a seton. The infected tissue is meticulously destroyed and the fistula tunnel collapsed.
Laser technology can eliminate complex fistulas without damaging the sphincter, thus avoiding potential post-operative issues such as incontinence, and facilitating a smooth and quick recovery.