Anal fistulas are one of the most common surgical condition encountered in modern surgical practice, and one of the
Fistulas have been known in mankind since ancient times: Excavation of the ruins of Pompeii, which erupted in 726, unearthed an ancient bronze ‘fistula probe”, in a site known as “The house of the surgeon”. Improper treatment of fistulas can result in some of the most debilitating complications and a thorough knowledge of the problem is essential, to avoid complications.
Fistulas arise from a ring of glands, located in the lower rectum, known as the “Dentate line”. Once infection arises in one of these glands, an abscess may arise, which enlarges and results in pain, local swelling and fever Once the abscess drains, either spontaneously, or surgically, a residual tract results known as a fistula.
Surgical treatment of fistula depend on the depth of the tract: Simple, superficial fistulas may be treated by simple “laying open” or fistulotomy.
Deeper more complex fistulas require a stage approach, since they usually incorporate a significant amount of sphincter muscle, and dividing the muscle may result in some degree of anorectal incontinence.
The first stage in treating Complex fistula involve placing a small surgical drain or “seton” (Greek for “thread”), which typically remains in place for about 3 months. Once the fistula tract has “matured”, the infection has subsided, and the swelling (edema) subsided, the final corrective procedure can be performed.
The final procedure depends on the depth of the tract: More superficial fistulas may be treated by fistulotomy, since the tract is typically more superficial after the seton has been in place for three months. The deeper tracts may require a biological, absorbable “Fistula Plug”, which is concerted into collagen tissue within the tract, and closes the fistula without cutting any tissue, and without risk of incontinence. The “Fistula Plug” was invented by Dr David Armstrong, and is used throughout the world.