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What is high fistula in ano and how to treat it?

Tuesday, 22 November 2005
Answered by: Dr. Suneet Sood
Consultant Surgeon,
Metro Multispecialty Hospital,
NOIDA, UP
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Q. What is high fistula in ano? Is surgery the only possible treatment or can it be cured by medication or by any alternative form of medicine such as Ayurveda or Homeopathy? If surgery is a must, can there be some post operation complications or is it totally safe? How much time is required after the surgery for complete and will it require prolonged bed rest? Is there a chance of recurrence following surgery? Is there any risk of losing normal muscular control at the anus?

A.  A fistula in ano is a track that develops from the inner lining of the anus through the tissues that surround the anal canal. (The anal canal is the last 3-4 cm of the intestine, and ends at the anus.) The track opens into the skin near the anus. The track gets repeatedly infected by bacteria in the stool, becomes painful, and discharges pus. A high fistula takes a long path and goes through an important muscle, the levator ani. The following link will show images of anal fistulas: http://www.netterimages.com/images/vpv/000/000/004/4310-0550x0350.jpg, http://www.cem.org.hk/gallery/albums/album18/fistula_in_ano.thumb.jpg Fistulas are treated by surgically removing the entire false track, and the surrounding tissues. However, an alternative therapy is the Ayurvedic thread therapy, first used 2500 years ago by Sushruta. It is very effective but not feasible in all fistulas, as the track is sometimes too tortuous to be threaded. Surgery for high fistula is not dangerous, but quite difficult. Recurrence rates may reach 10-20%. Loss of ability to control stool is the worrying postoperative complication. This complication of incontinence does not occur after surgery for low fistula. Incontinence is also unlikely after thread therapy, even if the fistula is high. Bed rest = 1-3 days; away from job = 2-4 weeks. Pain after surgery: may be significant for 1-2 days, but subsequently there is very little pain.

A.  A fistula in ano is a track that develops from the inner lining of the anus through the tissues that surround the anal canal. (The anal canal is the last 3-4 cm of the intestine, and ends at the anus.) The track opens into the skin near the anus. The track gets repeatedly infected by bacteria in the stool, becomes painful, and discharges pus. A high fistula takes a long path and goes through an important muscle, the levator ani. The following link will show images of anal fistulas: http://www.netterimages.com/images/vpv/000/000/004/4310-0550x0350.jpg, http://www.cem.org.hk/gallery/albums/album18/fistula_in_ano.thumb.jpg Fistulas are treated by surgically removing the entire false track, and the surrounding tissues. However, an alternative therapy is the Ayurvedic thread therapy, first used 2500 years ago by Sushruta. It is very effective but not feasible in all fistulas, as the track is sometimes too tortuous to be threaded. Surgery for high fistula is not dangerous, but quite difficult. Recurrence rates may reach 10-20%. Loss of ability to control stool is the worrying postoperative complication. This complication of incontinence does not occur after surgery for low fistula. Incontinence is also unlikely after thread therapy, even if the fistula is high. Bed rest = 1-3 days; away from job = 2-4 weeks. Pain after surgery: may be significant for 1-2 days, but subsequently there is very little pain.

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