Dr Naseem Mirbagheri:
A fistula is a track or a tunnel between the inner skin of the anal canal and the outside skin. It’s a common problem among the young, and old. And you know you might have a fistula because you might have an occasional discharge from the back passage, usually accompanied by pain, and a lump.
Fistulas come in two forms, simple and complicated.
A so-called simple fistula is where there is a track, or tunnel, directly from an infected gland in the anus, to the skin. And it does not involve more than a third of the sphincter muscles.
A complicated fistula on the other hand, is one where there are multiple tracks, or those due to chronic diseases, like inflammation in the bowel, from Crohn’s disease, things like cancer, radiation treatment side effects, and sometimes sexually transmitted diseases.
The treatment of anal fistulas depend on what’s caused them, and where the track or tunnel goes. The range is from a simple fistulotomy, to a more involved procedure that may require more than one operation to fix the problem. A fistulotomy is performed under general anaesthetic, and opens up the fistula to allow healing. The potential problem is that this may involve the sphincter muscle, and the fistula track may go through more muscle than it’s safe to cut. In the right patient, a fistulotomy is more than 90 per cent successful. But, it isn’t right for everyone.
Other treatment options include procedures such as insertion of a seton, which is a rubber band-like thread, through the fistula track, which aims to keep the tunnel open. However, a seton only aims to control the complications associated with fistula, like infection, and does not fix the underlying problem.
There are more complex procedures, such as mucosal advancement flap, where the fistula opening is covered from the inside with a healthy tissue. Or a LIFT procedure, where the track is closed off halfway. Both these operations are successful 50 per cent of the time.
So in summary, fistula is a common anorectal problem, both in the young and old, and in most people is a pretty benign condition. But sometimes, due to the delicate anatomy of the anal canal, treatment can be difficult, and at this stage, no perfect surgery is yet available.