Fistula By Proctonova -

Fistula By ProctoNova

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Fistula-in-Ano

It is a track lined by granulation tissue which connects peri-anal skin superficially to anal canal; anorectum or rectum deeply. It usually occurs in a pre existing anorectal abscess which burst spontaneously.

Fistula-in-ano can be:

Cryptoglandular—90%
Non-cryptoglandular (other causes)—10%.

Fistula

Classification

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Low level fistulas—these open into the anal canal below the
internal ring.
High level fistulas—these open into the anal canal at or
above the internal ring.
Intersphincteric fistula.
Transphincteric fistula.
Supralevator fistula
Extrasphincteric fistula.
Simple fistula without extensions.
Complex fistula with extensions.
Single external opening.

Multiple external openings which are often seen in-:

Tuberculosis, Ulcerative colitis, Crohn’s disease lymphogranuloma venereum (LGV), Hidradenitis Suppurativa, Actinomycosis.

Fistula

Principles of Management

Fistula

Surgeries

Identify the cause cryptoglandular or other:-

Delineate exactly the fistula anatomy— MRI/EUS.
Identify relation of fistula to anal sphincter.
Drain all sites of infection.
Eradicate track and secondary extensions.
Preserve anal continence function.

The primary objectives are to eradicate the tract and drain all associated sites of infection while simultaneously preserving anal continence.

Fistula

Surgeries

FILAC – Fistula laser closure of fistulous track.
DLPL- Distal laser proximal ligation
Laying open the fistula—
fistulotomy with curetting
Fistulectomy
Fistulectomy with primary repair
Fistulectomy with primary repair
Fistulectomy with secondary repair
LIFT technique (Ligation of intersphincteric fistula track)
Seton technique (Latin-seta—a bristle)
Colostomy—lay open,
fistulectomy, later closure of colostomy—for high type.
VAAFT procedure (Video assisted ablation of fistulous track.

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