Fistula
Introduction
Anorectal symptoms and complaints are common and may be caused by a wide spectrum of condition.Since many patients with symptoms related to anorectal region do not seek medical advice or attention. Anal fistula or Fistula â€"in-Ano is a common anorectal problem in which an abnormal connection develops between the inner surface of the anal canal and the skin around the anal verge.
Pathopysiology ( Why Do Fistula Develops )
Anal gland located between the two layers of the anal sphincter (muscle which open and close the orifice) and draining into anal canal are the sites where these Fistulae originate.It is a blockage of outlet of these glands which causes secretions to accumulate inside and an abscess can form which can eventually point to the skin surface.The track formed by this process is the Fistula.
Treatment on Fistula: KSHARSUTRA THERAPY
Acharya Sushruta (Father of Surgery) mentioned three types of treatment.
General line of treatment includes mainly preventive & also administration of medicines orally. The surgical line of treatment has been described very elaborately. Para Surgical treatment includes cautery by thermal & chemical substances i.e. kshar sutra.
KSHARSUTRA
KSHARSUTRA is a medicated thread prepared by linen thread, Apanarg Kshar (Achyranthusaspera), Snuhi ksheer (Latex of euphorbia nerifolia) and Haridra Churna (Curcumalonga).
BENEFITS OF KSHARSUTRA THERAPY:
- It is O.P.D level procedure.
- Cost effective.
- Very less recurrence rate.
- Patient can do his routine work or duties from very same day of procedure.
- Cutting & healing goes simultaneously.
The aim of treating Fistula is to prevent it from occurring again with no damage to the sphincter muscle.
Principles of Treatment
- To identify the Fistula tract or path with its internal and external opening.
- To destroy this Fistula path.
- To preserve function of anal sphincter (muscle which controls ability to pass stools)
Treatment Available With Us..
- Fistulotomy (Lay Opening of Fistula in Ano).
- Fistulectomy (Excision of Entire Fistula Tract).
- VAAFT (Video Assisted Anal Fistula Treatment).
The Fistula tract is cut open a raw wound.This wound requires daily dressing and is painfull.This option is not indicated for Fistula that involve the entire anal sphincter as surgery may damage the sphincter.
A probe or dye inserted into the tract from one opening to other and define the entire tract which is excised in toto leaving behind the raw surface area which requires daily dressing till complete healing.
This procedure is done with a endoscope called Fistulascope and is done in two steps
- Diagnostic step :
- Therapeutic step :
In first step Fistulo scope is passed through external opening to make out the tract and to identify the internal opening by locating where the light is reflected on the anal wall.
After complete identification of tract and internal opening in the second step a suture (purse string) with 2-0 mersilk is taken around the internal opening so as to close snugly. A semicircular stapler or linear stapler could also be used. Then the Fistula tract is debribed with a endo brush (Fistua brush) and the scraping send for HPE fibrin glow is injected near the inner end (row closed ) and coagulation of the whole wall is done with unipolor electrode with simaltanous withdrawal of Fistuloscope.