Pain, which is usually constant, throbbing and worse when sitting down Skin irritation around the anus, including swelling, redness and tenderness Discharge of pus or blood Constipation or pain associated with bowel movements Fever
Fistulotomy: This is used in 85-95% of cases and involves cutting open the whole length of the fistula in order for the surgeon to flush out the contents. This heals after one to two months into a flattened scar.
Advancement flap procedures:
This option is usually when the fistula is considered complex, or is there is a high risk of incontinence. The advancement flap is a piece of tissue that is removed from the rectum or from the skin around the anus. During surgery, the fistula tract is removed and the flap is reattached where the opening of the fistula was.
VAAFT: Video Assisted Anal Fistula Treatment
Video-assisted anal fistula treatment (VAAFT) is a novel minimally invasive and sphincter-saving technique for treating complex fistulas. Karl Storz Video Equipment is used. Key steps are visualization of the fistula tract using the fistuloscope, correct localization of the internal fistula opening under direct vision, endoscopic treatment of the fistula and closure of the internal opening using a stapler or cutaneous-mucosal flap. Diagnostic fistuloscopy under irrigation is followed by an operative phase of fulguration of the fistula tract, closure of the internal opening and suture reinforcement with cyanoacrylate. The main feature of the VAAFT technique is that the procedure is performed entirely under direct endoluminal vision. With this approach, the internal opening can be found in 82.6% of cases. Moreover, fistuloscopy helps to identify any possible secondary tracts or chronic abscesses. The VAAFT technique is sphincter-saving, and the surgical wounds are extremely small.
Surgery – Excision of Fistula tract