Surgery for anal fistula
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A fistula is an abnormal connection between two parts, which occurs inside the body. Symptoms can range from a slight itching or stinging to severe sharp pain, and even bleeding or pus. Surgery is the most effective treatment for those patients who suffer it.
An anal fistula is a path that connects the anal canal with the skin. It is usually caused by the infection of glands that are in the so-called "dentate line", which is the area where the rectum ends and the anal canal begins..
In most cases the infection is spontaneous or idiomatic , although it is sometimes associated with inflammatory bowel diseases, such as Crohn's disease.
The acute form of the infection is anal abscess, which is usually controlled with antibiotics or by surgical debridement.. 50-70% of cases subsequently develop into the development of a fistula.
Normally patients undergo anal fistula surgery. There are only some exceptional cases of spontaneous resolution and that do not require surgical intervention. However, when the fistula is already established, the only curative treatment is surgery.
Simple or complex fistulas
There are different ways to treat each type of fistula. Depending on whether the trajectory of the fistula crosses or affects more or less the anal sphincter musculature (constituted by the internal and external anal sphincter), the fistulas are classified as simple or complex , which conditions the surgical technique to be used .
In the case of simple fistulas, which affect less the sphincters, the most used technique and with better long-term healing results is the laying-flat, which consists of opening the tissue through which the fistula passes as a book. that heals later. More recently, the "lift" technique has been developed, which barely cuts muscle fibers.
Complex fistulas, which would include the deepest trajectories with much sphincter muscle involvement, recurrent fistulas (already operated previously) or those associated with other intestinal diseases, require the application of other techniques also of greater complexity, in order to preserve the sphincter musculature and its function, to avoid possible postoperative incontinence.
In addition, therapeutic options must be taken into account. These range from the so-called "rectal advancement flap" (a kind of plasty with the rectal mucosa), the use of biological glues, patches of scarring substances (Surgisis) and even the most recent use of the laser period (FILAC: Fistula-tract Laser Closure).
Postoperative
Depending on the technique used there may be some more specific rules, but generally all that is necessary is to continue a relative rest the first days of postoperative , with analgesics if necessary and good hygiene of the anal area, recommended in some cases the application of ointments that favor the healing of wounds.
