Perianal Fistula (Anal Fistula)

In terms of terminology, it is confused with anal fissure; although they are diseases of the same region, they are two completely different diseases.

Perianal fistula is an infected tunnel that has developed in the anal region (anus). The tunnel has two ends, one is on the inside of the anus, the other hole is on the outside, in the skin close to the anus. There is discharge from this outer hole. This is the most important and common symptom of perianal fistula.

Perianal fistulas usually occur as a result of a developed abscess. In the last part of the large intestine, which we call the anal canal, there are structures called glands, close to the exit; an infection developing in these glands results in abscess formation.

Abscess developed in the perianal region either drains on its own or the doctor drains it, after the abscess is healed, it has a rate of 50%. What remains is the perianal fistula.

Drugs are useless in the treatment of perianal fistula, it does not heal by waiting, and may even grow or become complicated. The fistula cannot heal unless the fistula tract, which we liken to a tunnel, is destroyed.

The tunnel-shaped infected tract (=fistula tract), which is a part of the fistula, has different sizes and shapes and is in close relationship with the muscles around the anus that are used to hold the toilet.

 What makes the treatment difficult is the relationship of the fistula tract with the muscles and the complicated path that the tract follows.

 

There are different types of perianal fistula:

 

Perianal fistulas are classified according to the path followed by the tract and its relationship with the anus muscles. If we classify from simple to complicated;

 

• Superficial fistula, (simple fistula)

• Intersphincteric fistulas (simple fistula - most common)

• Transsphincteric fistulas (complicated fistula)

• Suprasphincteric fistula (complicated fistula)

• Extrasphincteric fistula (complicated fistula - least common)

• Horseshoe fistulas (complicated fistula)

 

Symptoms of perianal fistula

• The most common symptom is discharge from a hole around the anus, that is, from the fistula mouth.

• Pain in the perianal area

• Around the anus skin irritation

• Hardness around the fistula mouth

• Anal itching and wetness, due to discharge




 

Examination methods

• Transanal ultrasonography It shows the course of the fistula and its relationship with the muscles. Giving hydrogen peroxide from the fistula mouth during the examination increases the success of the examination.

• Fistulography is the film taken after medication is given from the fistula mouth, it gives an idea about the course of the fistula tract. (Is it a straight tract or curved, is there a single tract or are there side tracts in the tunnel), it helps us find the location of the other hole in the intestine and plan the surgery.

• Pelvic MRI (with contrast) is a film taken after intravenous drug administration, it gives an idea about the course of the fistula tract (is it a straight tract or curved, is there a single tract or are there side tracts in the tunnel). It shows the relationship of the fistula tract with the muscles that control the anus and helps in surgery planning.

• Pelvic CT (contrast-enhanced) is a film taken after intravenous drug administration, it gives an idea about the course of the fistula tract (plain Is it a tract or curved? Is there a single road or are there side roads in the tunnel?) It shows the relationship between the muscles that control the anus and the fistula tract and helps in surgery planning.


 

Examinations only give an idea, their reliability is not very high, What is important are the findings during the intervention. At the beginning of the surgery, a blue dye is administered through the mouth of the fistula and this dye is followed to try to remove the fistula.

 

Treatment options

• Fistulotomy: It is used for simple superficial fistulas, it requires post-operative dressing and the application of these dressings by the doctor performing the surgery increases the success of the surgery.

• Fistulectomy: Fistula. It is the removal of the tract, but there is a high probability of recurrence in cases where the internal hole is not made completely.

• Seton technique: Rope etc. through the fistula tract (tunnel)..&nb sp; is threaded and the ends are tied, and through this rope the tissues are cut within weeks, just like the rope cuts ice.

• Rerouting (creating a new path) technique: It is a method of simplifying the fistula by changing the path of the complicated fistula.

• Laser fisulectomy (FİLAC- Fistula LaserClosure)

Situations where it can be applied

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Complicated fistulas

Those who have weakness in the anus (anus) muscles

Those who have had unsuccessful surgeries many times

Situations where it cannot be applied

• Rectovaginal fistulas

• Superficial fistulas

• If there is an abscess associated with the fistula tract

• If the fistula has side tracts 

 

Several techniques can be used together in fistula treatment, this is something the surgeon will decide with his experience.

 

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