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Herekar park Building
Rajyog B Wing 3 First Floor
Near Kamala Nehru Garden
Off Bhandarkar road
Deccan Gymkhana PO
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Fistula in Ano
It is a track with at least the two openings. One opening is inside the anal canal. While others open outside on the skin covering either the perianal area or the skin covering the buttocks. Complex branching fistula tends to have multiple external openings. The variation ranges from relatively simple fistula with the single straight track to the one that has multiple branching tracks.
Each fistula has individual or unique characteristics. One of the fistulae types the High fistula that needs special attention. It may have involved the muscles of bowel control.
After an Anorectal abscess has been drained, a track may persist, with a small amount of discharge through the external opening. If that opening seals at skin level, it gives rise to the recurrent abscess. Almost 50% of patients of ruptured abscess develop fistula-in-ano.
Fistula in Ano is a mildly painful condition. Pain is pronounced especially during the passage of the motion.
It can also cause a small amount of bleeding and purulent discharge during the act. Some patients may get a fever with or without chills.
Some experience discomfort which gets worse when sitting on the chair for a longer period.
The diagnosis is made by the detailed history and clinical examination that includes a digital rectal examination.
Endorectal Ultrasound examination and MRI scanning are useful in getting more information about the fistulous tracks.
Few patients are evaluated for the presence of other diseases like Crohn's disease, cancer or chronic infections like tuberculosis.
Surgery offers the best option.
Most patients with simple fistula are benefited by fistulotomy. It is a simple procedure of laying open the fistulous tract and allowing it to heal from the inside out. Regular cleaning and dressing are required which the patient learns quickly and the wound heals completely over the period. Sitz bath helps many patients. The patient is advised to continue stool softeners. It helps in avoiding hard stools. Although the healing speed differs from person to person, generally the perianal wounds very fast. Diabetics and immunocompromised patients take a longer period. Some patients may require the use of a Seton, which is passed through the fistulous tract and is progressively tied over the period. This is preferred for the high type of anal fistula. Some complex fistulae may require procedures like Advancement flap, LIFT procedure (ligation of the intersphincteric fistula tract) and others. Other techniques like the use of laser technology and Fibrin glue and Bioprosthetic plug are also used.
It is helpful to follow the instructions in the post-operative period
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