It is a tunnel between the skin around the anus and the intestines. In general, the abnormal passageways formed between the last part of the large intestines and the skin around the anus are called anal / perianal fistulas. It mostly occurs when the pus-filled abscess structure that occurs with the chronicization of infections in this region finds its way. In other words, it is due to abscesses that do not heal completely. If there is a blockage at the fistula outlet, recurrent chronic abscesses occur.
What are the Symptoms of Anal / Perianal Fistula?
Anal / Perianal fistula symptoms can give the first symptoms with tenderness and redness in that area.
- In the anus area; tenderness,
- Pain in the anus area, palpable warm swelling if an abscess develops,
- Flushing of the skin,
- The discharge and the stench,
- There may be irritation and itching.
- If inflammation spreads throughout the body, fever and chills may occur.
- Depending on the width of the fistula opening, feces and gas may come out.
- If it is connected to the bladder, urine may flow. If it extends to the vagina, gas and stool may come from the vagina.
How is Anal / Perianal Fistula Diagnosed?
First of all, what the patient tells and a good regional examination are important. During the examination, if necessary, instruments called anuskop * rectoscope can be used and we can see inside.
In addition, Fistulography / MR fistulography is important in the detection and localization, height and type determination.
How to Treat Anal / Perianal Fistula?
There is no treatment with drugs, but antibiotics for infection may be useful in drying it a little at the beginning, but it does not eliminate it.
Treatment can be done surgically. The type of fistula, its location and the damage it has left determines the type of treatment. The aim is to ensure adequate drainage, prevent infection and achieve healing.
- Peri anal fistulectomy : After the fistula pathway is determined, if it is superficial, it is in the form of opening or removing the pathway. It is generally suitable for deep and uncomplicated (difficult) cases.
- Binding of the pathway / Seton method: After the skin is opened along the fistula channel, rubber or nylon threads are threaded and tied, then a weight is tied to the end of the threads (100-150gr) and the threads are tightened over time. Over time, the threads allow the muscles to heal while cutting themselves. Finally, the procedure ends by itself and the fistula tract is eliminated. This method has a high success rate (80-85%).
- Fistula plugs and adhesives: Special substances are placed along the fistula tract after scraping and adhesion is achieved (50-60% success rate).
- Flap Shift to Fistula: After the fistula tissue is removed, the defect is closed by sliding the surrounding tissues with a special method.
- Laser Application: After the fistula tract is scraped, the laser is entered inside and burned to provide closure. The success rate is around 50 - 60%. Multiple applications can be performed.
- Colostomy: If the perianal / anal fistula is high and complicated, then the feces should be prevented from passing down for a certain period of time and should be allowed to pass through the secondary route, this is called colostomy. In other words, the intestines are weighted against the abdominal wall with a special method and the stool exits from there. When the underlying treatment is finished, the colostomy is closed for re-passage.
