Fistula Treatment - Types, Diagnosis, Surgery & Risks

Diagnosis of Anal Fistula

Usually, an anal fistula can be diagnosed by visual examination but your doctor may suggest some additional examination for a clearer view. Some common diagnostic tests include:

• Physical examination: Most of the time, your doctor can diagnose an anal fistula by just doing a physical exam.
• Digital rectal exam: This test includes inserting a lubed finger into the anus to look for any abnormal growths.
• Anoscopy: This test is performed to check the lower rectum with an anoscope to examine the anus and rectum.
• Imaging Tests: Sometimes, the doctors also do an ultrasound or MRI to get a clearer look at the fistula.

Treatment of Anal fistula

There are various treatment options available for anal fistula, including:

Fistulotomy

A fistulotomy involves the following steps:

1. The doctor administers local anesthesia to numb the affected area.
2. Next, he will make a small incision to expose the fistula tract.
3. Then he carefully dissects the tract, removing any infected tissue.
4. The doctor then uses a probe to explore the depth of the fistula and remove any debris.
5. Then the doctor cleans the area with an antiseptic solution to prevent infection.
6. In the end, the doctor closes the internal opening of the fistula with sutures.
7. Then the doctor places a sterile dressing over the incision site to promote healing.
8. Finally, the patient receives post-operative instructions and pain relieving medications if necessary.

LIFT (Ligation of Intersphincteric Fistula Tract)

Here’s how LIFT is performed:

1. The surgeon administers anesthesia to numb the area around the anus.
2. The surgeon makes an incision in the skin near the fistula to access the area.
3. Using a special tool, the surgeon locates the internal opening of the fistula within the anal canal.
4. The fistula tract near the internal anal sphincter muscle is tied off with a suture to close it. Closing the internal opening helps prevent the fistula from recurring.
5. The incision is then closed, and the procedure is completed.

The LIFT procedure is generally safe and effective but may not be suitable for all patients. The decision to undergo the LIFT procedure should be made by an experienced proctologist depending on the individual health condition.

Seton Placement

Here’s how a seton placement is done:

1. Anesthesia is administered to numb the area where the Seton will be placed.
2. The surgeon makes a small incision to access the affected area.
3. A small piece of plastic or rubber called a Seton is inserted under the skin through the incision.
4. The Seton is carefully positioned and tied to form a loop, allowing for continuous drainage of fluids.

Advancement Flap Procedure

1. The patient is given local anesthesia to numb the treatment area.
2. The surgeon makes a small cut or incision at the site of anal fistula.
3. Then the surgeon identifies the tract (abnormal tunnel between anus and skin) and clean out the tunnel, infected and unhealthy tissues.
4. Then the surgeon cut the healthy tissue near the fistula and then the flap is used to cover the internal opening of the fistula.
5. The surgeon sutures the flap into place, securing it in its new position.
6. Antibiotics or medicines may be prescribed after the procedure.

Laser Surgery

Here’s a how the advanced laser surgery for fistula is performed:

1. Before a laser surgery for anal fistula, the patient is typically administered local anesthesia.
2. A small probe is then inserted into the fistula tract, guided by an endoscope or other imaging techniques.
3. The laser energy is delivered through the probe, targeting and destroying the tissues along the fistula tract.
4. The laser energy effectively seals off the fistula tract by creating a controlled thermal injury.

Best Treatment Option for Anal Fistula

Laser surgery is one of the best treatments for anal fistula. This procedure offers various benefits over traditional procedures. Firstly, laser surgery is minimally invasive, resulting in less pain and faster recovery times for patients. Additionally, the laser effectively targets and removes the fistula tract, reducing the risk of recurrence. The precision of the laser also helps preserve the surrounding healthy tissue. Furthermore, the procedure is known for its lower complication rates compared to other surgical options. Therefore, laser fistula surgery is considered a highly effective treatment for anal fistulas, owing to its optimal outcomes.

Candidates for Laser Anal Fistula Surgery

• Patients with recurrent anal fistulas that have not responded to conservative methods.
• Individuals experiencing persistent pain, swelling, and discharge from the anal area.
• Those with complex or high-risk fistulas, such as those extending into the rectum or involving multiple tracts.
• Patients with underlying medical conditions, such as Crohn’s disease or immunodeficiency, increase the risk of complications.
• Individuals with symptoms affecting their quality of life, such as frequent abscess formation or difficulty with bowel movements.
• Those who have had previous unsuccessful attempts at fistula repair and are seeking alternative surgical options.
• Patients with fistulas that are causing recurrent infections and abscesses.
• Individuals with fistulas that are associated with other anorectal disorders, such as hemorrhoids or anal fissures.
• Those who have been advised by their healthcare provider that surgery is the most appropriate treatment option for their anal fistula.

Benefits of Laser Anal Fistula Surgery

• Laser anal fistula surgery offers a minimally invasive approach to treating anal fistulas.
• The use of laser technology in this procedure ensures precise and targeted treatment.
• Compared to traditional surgical methods, laser anal fistula surgery results in less pain and discomfort for the patient.
• The recovery time after laser anal fistula surgery is typically shorter than with conventional surgery.
• This procedure has a lower risk of complications, such as infection or incontinence, compared to other treatment options.
• The high precision of laser technology minimizes the risk of damage to nearby structures during the procedure.
• The use of lasers in this surgery helps to promote faster healing and tissue regeneration.
• Patients who undergo laser anal fistula surgery often experience improved overall quality of life postoperatively.
• The reduced risk of complications associated with laser anal fistula surgery makes it a safer option for many patients.
• This procedure is often performed on an outpatient basis, allowing patients to return to their daily activities sooner.
• The use of lasers in this procedure allows for better visualization and identification of the fistula tract.
• Laser anal fistula surgery can effectively seal the fistula tract, reducing the risk of recurrence.
• Laser surgery is particularly beneficial for patients with multiple or recurrent anal fistulas.
• Laser anal fistula surgery minimizes the need for multiple procedures, reducing the overall treatment time.
• The reduced pain and discomfort associated with laser anal fistula surgery improves patient satisfaction.

Overall, laser anal fistula surgery offers numerous benefits, including improved outcomes, faster recovery, and reduced risk of complications.

Preparation Tips for Laser Anal Fistula Surgery

• Consult with your surgeon to understand the procedure and ask any questions you may have.
• Follow any pre-operative instructions given by your surgeon, such as fasting or medication restrictions.
• Ensure you have a reliable means of transportation to and from the surgical facility.
• Arrange for someone to accompany you on the day of the surgery, as you may require assistance.
• Wear loose and comfortable clothing on the day of the surgery.
• Avoid consuming food or drink after midnight on the day of the surgery, as directed by your surgeon.
• Take any prescribed medications as instructed by your surgeon.
• Follow any specific bowel preparation instructions provided by your surgeon.
• Remove any piercings or jewelry in the surgical area before the procedure.
• Communicate any allergies or sensitivities to the surgical team beforehand.
• Prepare your home for post-surgery recovery, including stocking up on necessary supplies like gauze, ointments, and pain medication.
• Plan for adequate rest and recovery time after the surgery.
• Follow all post-operative instructions provided by your surgeon for wound care and pain management.
• Attend all scheduled follow-up appointments to monitor your healing progress.
• Maintain good hygiene practices to minimize the risk of infection during the recovery period.

Recovery Tips After Laser Anal Fistula Surgery

• Take prescribed pain medication as directed.
• Apply ice packs to reduce swelling and discomfort.
• Follow a soft diet to avoid straining during bowel movements.
• Keep the anal area clean and dry to prevent infection.
• Avoid sitting for prolonged periods to reduce pressure on the surgical site.
• Use a cushion or donut pillow to relieve pressure while sitting.
• Take regular warm sitz baths to promote healing and alleviate pain.
• Avoid heavy lifting or strenuous activities that could strain the surgical area.
• Follow the post-operative care instructions provided by your surgeon.
• Attend all scheduled follow-up appointments to monitor the healing progress.
• Report any unusual symptoms or complications to your doctor.
• Practice good hygiene, including washing hands before and after caring for the surgical site.
• Avoid smoking and alcohol consumption, as they can delay the healing process.
• Stay hydrated and maintain a balanced diet to support healing.
• Get plenty of rest and allow your body time to recover.
• Gradually increase physical activity as advised by your surgeon.
• Use over-the-counter stool softeners if needed to prevent constipation.
• Wear loose-fitting clothing to minimize irritation in the surgical area.
• Avoid using harsh soaps or wipes on the surgical site.
• Stay positive and patient throughout the recovery process.

Risks and Complications Associated with Laser Anal Fistula Surgery

• Infection: Laser anal fistula surgery carries the risk of developing an infection at the surgical site.
• Bleeding: There is a possibility of bleeding during or after the surgery, which may require additional medical intervention.
• Pain: Patients may experience mild pain and discomfort following laser anal fistula surgery, which can be managed with pain medication.
• Scarring: The formation of scar tissue is a potential complication of laser anal fistula surgery.
• Fistula recurrence: There’s a risk of recurrence of fistula even after surgery.
• Incontinence: Rarely, laser anal fistula surgery can lead to temporary or permanent loss of bowel control.
• Allergic reactions: Some patients may experience allergic reactions to anesthesia or other medications used during the surgery.
• Fistula tract closure failure: In some cases, the laser may not effectively close the fistula tract, requiring further treatment.

Cost of Laser Anal Fistula Surgery

The cost of fistula treatment in India can be as low as INR 30,000 to as high as INR 65,000, depending on the severity of the condition. However, the final cost of the surgery may be different for each individual depending on various factors such as hospitalization charges, the severity of the condition, type of procedure, cost of the diagnostic test, anesthesiologist fee, patient’s age, location etc.

Is Laser Fistula Surgery Covered Under Health Insurance?

Yes, health insurance generally covers the cost of laser anal fistula surgery in India. The extent of coverage depends upon the specific policy chosen by the insured individual.

It is important to note that while surgical treatment expenses for anal fistula are typically covered, medical treatments may not fall under the purview of the insurance policy. Additionally, to be eligible for a claim, the insured person must undergo hospitalization for a minimum duration of 24 hours. The option for payment directly to the hospital or reimbursement from the insurance provider is available to the policyholder.

Upon approval of the claim, the insurance company will cover the whole treatment expenses, diagnostic tests cost, medications, hospitalization charges, and other essential expenses.

Some common insurance providers who usually cover the cost of laser anal fistula surgery include Oriental, Religare Health, Manipal Cigna, United India Insurance, Care Health, New India Insurance, Star Health & Allied, Bajaj Allianz General Insurance, ICICI Lombard, and Max Bupa Health Insurance.