Anal Fistula

Anal Fistula the management of convoluted anal fistula remains a test for specialists and a baffling issue for patients. Treatment expects to cure the condition, with seepage of the related contaminated organ abscess and annihilation of the fistula tract. The greater part of perianal diseases are either idiopathic or crypto-glandular in inception. All techniques for fistula repair depend on the disposal of the fistula interior opening to the anal gland. Anorectal abscess and the fistula that it may bring about, are long-term processes, initially portrayed toward the start of the recorded medical history, as a component of the ''Corpus Hippocraticum'' in a treatise termed ''On Fistulae''.

The notable reasons for a typical/confused abscess and fistula, including inflammatory bowel disease, contagious disease, mycobacterial contamination, neoplasm and injury. Fistulas, auxiliary to these procedures are named complex and require the utilization of nonstandard systems for management. The most regular giving grumblings of patients a anal fistula are swelling, agony and release. The previous two manifestations are normally connected with a abscess, when the outside or optional opening has shut or has neglected to create Anal fistula may be mistaken for suppurative hidradenitis and pilonidal sinus and the specialist should be mindful so as to make the right determination.

The advancement of rectal flap technique would be appealing with less sphincter muscle to be divided. Avoidance of contour defects, experiencing less pain due to the absence of a perineal wound and a faster healing process are the AMF (advancement mucosal flap) advantages. Beside these procedures, fistulotomy, fistulectomy and AMF with seton have also been used as new techniques for fistula treatment. Sphincter-sparing procedures are the standard treatment of anal fistula. The search for the effective treatments, not compromising continence has led to the development of the following techniques: 1) Anal fistula plug 2) Ligation of the intersphincteric fistula tract (LIFT) 3) Fibrin glue 4) VAAFT

January 2005 and 31st March 2011 247 patients presenting with anal fistulas were treated at the University Hospital Tor Vergata and were included in the present prospective study. Mean age was 47 years (range 16-76 years); minimum follow-up period was 6 months (mean 40, range 6-74 months). Patients were treated using 4 operative approaches: fistulotomy, fistulectomy, seton placement and rectal advancement flap. Data analyzed included: age, gender, type of fistula, operative intervention, healing rate, postoperative complications, reinterventions and recurrence. Etiologies of fistulas were cryptoglandular (n = 218), Crohn's disease (n = 26) and Ulcerative Colitis (n = 3). Fistulae were classified as simple -intersphincteric 57 (23%), low transphincteric 28 (11%) and complex -high transphicteric 122 (49%), suprasphincteric 2 (0.8%), extrasphinteric 2 (0.8%), recto-vaginal 7 (2.8%) Crohn 26 (10%) and UC 3 (1.2%). The most common surgical procedure was the placement of seton (62%), usually applied in case of complex fistulae and Crohn's patients.