Laser Surgery Fistula

What is Fistula?

A fistula is an abnormal connection between an organ and another structure. The most common location for a fistula is around the anus, called anal fistulas. An anal fistula is a tunnel that runs from inside the anus to somewhere in the perianal skin. It usually follows perianal infection (such as hair root infection, boil or abscess) that didn’t heal the right way.

The second most common location is between two loops of intestine. Fistulas can also form between the:

Rectum and vagina
Intestine and skin
Intestine and bladder

Perianal fistulas are subclassified by their location and complexity (Figure 1). Anatomically there are two sphincters (internal and external), which are muscles that enable you to control bowel movements.

Fistulas can form across 1 or both sphincters (Figure 2). They also can form above or between the sphincters. Some fistulas start high up in the rectum and do not cross the sphincters at all. Fistulas can be simple (single tunnel) or complex (multiple tunnels).

If the fistula is located in the lower anal region and is subcutaneous or submucous in nature, it is classified as a low-level fistula. However, if it affects the higher anal or the pelvic-rectal region, it is considered as a high-level fistula. Depending on its effects on the sphincter muscles, a fistula is further classified as intersphincteric, transphincteric, suprasphincteric or extrasphincteric.

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Anal Fistula: Symptoms and Treatment

An anal fistula is a passageway that develops between the anus and the skin. This usually develops because of an anal infection.

Symptoms of anal fistulas include fever, bleeding from the anus or skin where the fistula has occurred, constipation, pain with stool passing, and swelling of the skin around the anus. Surgery is the only treatment that will close the anal fistula.

Vaginal Fistula: Symptoms and Treatment

A vaginal fistula is a passageway that develops between the vagina and other organs in the pelvis. Vaginal fistulas can be caused by having children, Crohn's disease, previous surgeries, or cancer. There are several types of vaginal fistulas, including:

Ureterovaginal fistula - which develop between the vagina and ureters
Urethrovaginal fistula - which develop between the vagina and urethra
Colovaginal fistulas - which develop between the vagina and the colon
Enterovaginal fistula - which develop between the vagina and small intestines
Rectovaginal fistula - which develop between the vagina and rectum
Vesicovaginal fistula - which develop between the vagina and bladder

Symptoms of vaginal fistulas can be hard to understand, but it really happens. It is important to be sympathetic with patients that have any or all of these conditions. Patients that have fistulas that occur between the vagina and colon, small intestines, or rectum will notice that they are passing gas and stool out of their vagina. Patients that have fistulas that occur between the vagina and ureters, urethra or bladder will notice that they are passing urine out of their vagina. Patients with vagina fistulas will also notice foul smells and vaginal soreness.

It is rare, but some vaginal fistulas can heal on their own. Most of the time the only way to treat any of the vaginal fistulas is with surgery.

Arteriovenous Fistula: Symptoms and Treatment

An arteriovenous fistula (AV fistula) is a passageway between an artery and vein. This fistula bypasses the capillaries, which normally join the arteries and veins together. This kind of fistula can develop randomly in the body or can be surgically created for patients who have kidney disease or require long-term dialysis.

Arteriovenous fistulas can occur anywhere in the body, but will all have the same symptoms. These include fatigue, swelling in the area of the fistula, lower blood pressure and bulging veins that look almost like varicose veins. If the fistula occurs in the lungs this poses a big problem and will have symptoms that include bluing of the skin and difficulty breathing.

If a patient is found to have a small AV fistula and it is not causing problems, then there will be no treatment. The patient will monitor their symptoms at home and will have doctors' visits to monitor and track their symptoms. Some AV fistulas will even close on their own. Patients that have an AV fistula in their lungs or have a large AV fistula will require surgery to correct the problem.

What is the best treatment for fistula?

“There is no fistula treatment without surgery as the fistula cannot heal on its own,” said Dr. A. Jina

Meera was worried when she heard her fistula treatment cannot be done with just conservative management.

Dr. A. Jina was quick to reassure her and explained how fistula surgery is a simple procedure.

Here are the two fistula treatment methods he recommended –

1 - Minimal-access method: Minimally-invasive surgery like VAAFT surgery causes less pain, is safer with no external scars, and has a quicker recovery period.“It is a day-care surgery so you can be discharged the same day and resume work the next day.”

2 - Open surgery method: The more conventional open-surgery method, also known as a Fistulectomy, lessens the chances of fistulae from recurring.“The recovery period may be longer in this method as it can take 4-6 weeks to heal post-surgery.” Fistula treatment without surgery is not a recommended option as fistulae rarely heal by themselves.

It is important you consult your surgeon as early as possible for appropriate fistula treatment.