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A young male (35) from Afghanistan, started observing pain
and small swelling around his anus. And within days it turned into a
discharging sinus. As an immediate precaution, the antibiotics course began for
next three months, with no improvements and it converted into fistula. The
patient needed urgent surgical intervention to drain away the pus for which he
stayed in the hospital for one week, even though daily dressings and medicines
could not help him, his pus continued.
After getting operated thrice in Afghanistan, he went to
Pakistan for a redo surgery. With problems continuing, he was unable to sleep,
sit or work due to unbearable pain. The pimple like swelling became as hard as
an apple that would resurface after surgery.
He decided to travel to India, wherein he got operated twice
at different hospitals in Delhi but these surgeries could not help him cure. In
view of his complicated fistula doctors at different hospitals had advised him
to undergo a colostomy- making a route for passing stool through the abdomen as
final treatment. He was unwilling to go through with this so he travelled back
to his country, losing all hope of recovery and living a normal life. One of
his fellows National advised him to consult Dr. Ashish Bhanot who he had
operated for a complex fistula and had come for a follow-up consultation.
Patient approached Dr Ashish Bhanot who performed final
surgery for him. Following the surgery, Dr. Bhanot said, “It was one of the
most challenging cases as he had already been under the knife a couple of times
and had curved fistula tracts that were extending more than 15 cm deep and
reaching up to root of penis and pelvic bones. It was patience and a very
strong desire to completely cure the disease that helped him.†A week after
surgery with regular dressing and personal hygiene there were visible signs of
recovery and he got cured completely within 6 weeks.
Dr. Bhanot elaborated, “Any type of surgery to treat an anal
fistula faces the challenge of finding the internal opening. The body’s healing
mechanism prompts a layer of epithelial cells to grow over the internal
opening. It is not completely fused shut, but may become difficult to find but,
the camera eliminates the blind probing of the tract and cuts the risk of false
tracts being accidentally created by the surgeon. It also makes it easier to
scrape out the contents in the tract. After the internal opening is identified,
it is then closed. As endoscope can pass through muscles one can reach fistulas
as long as 15 to 20 cms deep without cutting anal sphincters and preserving fecal
continence, even after the most complex procedures. The external opening stays
open for the secretions to drain out. Though there are chances of recurrence in
a few cases, it is one of the most scientific approaches with lowest morbidity
rates and very quick recovery. Not only that, it is tolerated by patients very
well as there are no big wounds, no risk of loss of control of stool and
flatus, no tightening or cutting by thread and very small dressing which
patients perform by themselves†he explained. This surgery by Dr Bhanot has
again proved that Surgery is a blend of Art and Science.
What
is Anal Fistula?
An anal fistula is a small
channel that develops between the end of the bowel and the skin near the
anus. It usually forms as a result of an infection that occurs in the tissue
lining the anal canal. Sometimes an anal fistula may occur as a
result of an abscess in the anal area, inflammatory bowel disease, tuberculosis
of the bowel, in the rectum and cancer of the bowel.
What
are the symptoms?
Diagnosis:
A digital rectal examination is sufficient to diagnose an anal fistula, but some patients may require additional tests like fistulogram and MRI to see the path of fistula.
Treatment:
Traditional Vs VAAFT
Conventional surgery
for fistula is called Fistulectomy. The doctor removes the
entire fistula from internal opening to the external opening by
surgery. Stitches are usually not put and the wound is allowed to granulate and
heal naturally. This form of treatment of is associated with
failure and pain. The internal openings and side tracts were often missed
causing recurrence. The conventional treatment at times resulted in
bowel incontinence which is due the damage to the sphincter muscles. The
resultant wound from fistula surgery also takes anywhere between six
weeks to three months to heal.
Video Assisted Anal Fistula Treatment (VAAFT) is a safe, painless, day-care and effective method for treating fistulas and even prevents their recurrence. It involves use of a fine endoscope that is used to traverse the entire fistula tract under vision. This helps the doctor identify the internal opening of the fistula tract in the intestinal wall. The doctor destroys the fistula using special electric current and then applies fibrin glue to close the tract completely. There are no wounds and there is no need for prolonged dressings. This procedure does not harm the sphincter muscle, which is always at risk of injury in open surgery.
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Dr Ashish Bhanot, Chief Bariatric Surgeon, Fortis
Healthcare, Shalimar Bagh, New Delhi
