Abstract

ADVANCES IN THE MANAGEMENT OF FISTULA IN ANO

Dr. Ajay Kumar Sharma*

Abstract

Fistula in ano is a notorious disease, commonly develops as a result of chronic sequence of an asymptomatic or symptomatic abscess in the anal gland, i.e. cryptoglandular in origin. Complex and recurrent fistula in ano probably develop from secondary to trauma, infection, radiation or chronic granulomatous infections etc. Most of the fistula in ano occurs in patients with a past history of pre-existing anorectal abscesses. Approximately 50% of perianal abscess end up in the form of an anal fistula. It is usually simple to locate the external opening of an anal fistula while finding of internal opening can be more challenging. Diagnosis of fistula in ano is done with digital rectal examination (DRE), probing of fistulous tract, proctoscopy, injection of diluted methylene blue dye in the tract, CT, MRI, fistulogram etc. Treatment of anal fistula should be aimed with minimal or without any injury to the sphincter muscles complex and control of localized sepsis without loss of anal continence. Newer treatment modalities like collagen plug, fibrin glue, advancement rectal flap procedure, VAAFT procedure etc, should be adopted as per complexity of fistula in ano along with conventional methods.

Keywords: Fistula in ano, fistulography, virtual CT fistulogram, MRI, collagen plug, fibrin glue, VAAFT etc.