The Anorectal Fistula. What Is It?
The anal area is a complex anatomical location. The anal canal is designed to store stool until such time as it can be discharged. As such, the anus is endowed with nerves (to sense the arrival of stool) and muscles (to hold the stool and then help to discharge it), and glands (to lubticate the stool and allow for an easier passage).
Unfortunately, the area can be plagued with a periodic infection which can become an abscess (a collection of pus), which either drains spontaneously to the skin of the buttocks, or must be drained by the proctologist, also known as a colorectal surgeon. Sometimes, this drained abscess becomes a chronically infected tract called a perianal or perirectal fistula. The fistula is difficult to treat successfully. In large cities such as Los Angeles, specialists are available to consult and help.
Why The Difficulty In Treating The Fistula?
The fistula tract is contaminated by bacteria. It is inflamed and drains chronically. Any operation designed to treat the fistula has a certain failure rate, as the operative area is contaminated. The easiest, and most likely method to succeed, is called a fistulotomy, whereby a part of the sphincter muscle overlying the fistula is cut, allowing the cavity to close, or heal from the inside out.
The problem with a fistulotomy is that many of these fistulas are deep and wide, running through the entire muscle surrounding the anus. To cut the entire muscular complex would leave the patient incontinent and unable to have any bowel or gas control. Several operations have been developed to get around this problem. They have variable success rates. They are:
- Fistula glue.
- Fistula plug.
- Advancement flap.
- LIFT (ligation of intersphincteric fistula tract)
Two New Operations. Better Success?
In the March 2014 issue of Diseases Of The Colon And Rectum, two novel approaches to curing the fistula are discussed.
The first is a Video-assisted anal fistula treatment. In this operation, a small video scope is inserted into the tract and an electrical probe was used under direct vision to cauterize and close the tract. No muscle was cut. 70% of patients were disease free at 2 years.
The second procedure, Laser ablation of the fistula tract, was performed in a similar fashion using laser as the energy source to obliterate the tract. A video scope was not used. The success rate was 82% at 1 year.
Both of these procedures show promise in safely healing fistula tracts. As in all new operations, confirmation by independent surgeons needs to be achieved. Hopefully, similar results will be obtained. More studies will be performed.
Los Angeles Colon and Rectal Surgical Associates.
The surgeons of Los Angeles Colon and Rectal Surgical Associates are board certified and experienced in treating all diseases of the colon, rectum and anus. If you have a fistula, or any other problem, call (310)273-2310 for a consultation. You will be examined and given time to ask questions in order to understand the complexities of your problem and the proposed solutions. Your consultation will be confidential.