Anal fistulas can be more or less complex. In all cases, surgery is required for treatment.
The fistula is one of the conditions in which the surgeon's experience is more related to the results. Therefore, it takes colorectal surgeons experts to treat them.
Why a fistula occurs?
When a fistula occurs, the skin near the anus is connected to inside through a path suppurative. This can occur either spontaneously or after an acute inflammation or abscess.
There are simple fistulas, in which the path is very close to the skin and covers too little of anal sphincters.
Other fistulas are more complex, with paths crossing the sphincter higher, branches, abscesses ... In these cases can be a really difficult problem to treat.
To assess the type of fistula, anal systematic exploration is required and, in many cases, a method of image as the anal ultrasound or pelvic MRI.
In any case, to treat fistulas always surgery is required, and this is very variable:
- In simpler cases simply open the way from the inner hole of the anus to the outside, cutting a small amount of sphincter muscle even under local anesthesia and sedation. This does not usually affect the ability to contain the air or feces, unless there are risk factors or previous injuries.
- The problem is more complex cases to them general or spinal anesthesia and specialized techniques that do not involve sectioning the anal sphincter is required.. Some of the most used are way ligation (LIFT), advancement flaps (as a graft), sphincter reconstructions, or certain biological glues.
Discomfort is usually scarce. Simple cases may not even require income, and return to normal activities is faster. It remains an open wound that requires hygiene disinfectant and some gauze to absorb secretion. Depositions not affect healing and usually painless.
In complex cases you may require a stay of 24-48 hours, and any restriction on the diet for a few days and wound care by a professional.
Fistula surgery, risks and complications
The main risk for treating fistulae that have difficulty is voluntarily retain gases or feces. There is some increased risk in complex cases, in which the already mentioned techniques to prevent or substantially decrease required.
Simple fistulas do not usually breed, and cured in over 90%. However, some particularly complex, with multiple paths and cavities may be very difficult to treat without altering the anal continence, with the risk of reproduction of even 30% or more.