Perianal fistula is the canal shaped connection between the anal canal, which is the last part of the colon, and the skin tissue around the anus. Patients complain about a pimple like wound around the anus and a bad smell coming out of there. More than 50% of the patients have a perianal abscess history.
Unless treated, constant contamination of the underclothes and pain disrupt the quality of life of the patients, may cause recurrent perianal abscesses and is also a risk factor for anal cancer development in the long term
As with hemorrhoidal disease and anal fissure, perianal fistulas have no conservative methods; only treatment technique is the surgical removal of this canal. Purpose of the surgical treatment is to remove infection and this pathological canal without disrupting patient?s control over gas and defecation and to prevent the disease from recurring. Therefore, it is very important to identify the perianal fistula typing using proctological and radiological methods before the operation. Since perianal fistula is a clinical condition that may frequently accompany inflammatory intestinal diseases (Crohn?s Disease, Ulcerative Colitis), patients should also be evaluated in this regard. Operation technique is decided in accordance with the fistula type, examination findings, previous perianal region operations, if any, and gas fecal control of the patient. Perianal fistulas are categorized in 4 groups depending on their relation to the muscles around the anus that provide gas and fecal control; Intersphincteric (Type I), transsphincteric (Type II), suprasphincteric (Type III) and extrasphincteric (Type IV).
The skin covering the fistula canal and a portion of the internal muscle are cut, and the inner and outer ends of the fistula are ligated. This way the canal is removed and transformed into an open wound which will heal spontaneously. It is a simple method that is applied to interphylactic fistulas and perianal fistulas with downward opening that do not contain many muscles.
2. SETON APPLICATION
This method is selected for highly open transsphincteric, suprasphincteric patients with poor gas or stool incontinence and with more than 50% are involved. The aim of this treatment is to prevent gas and stool incontinence. A suture material or rubber band called seton is passed through the canal. This way, it is aimed to drain fistula and recovery through fibrosis. After 6-8 weeks, the seton is removed and the fistulae are cut. This way, up to 75% success can be achieved. This method can provide success rates up to 75%.
3. ENDOANAL ADVANCEMENT FLAP METHOD
This method is applied for complicated fistulas. It is based on the principle of covering the section of the fistula opening into the rectum with healthy intestine mucosa. This is a sphincter protecting method. Reported relapse rates are between 13% and 56%
A. LIFT METHOD
Procedure involves placement of a seton to the perianal fistula, then, 6-8 weeks later, incision of the fistula tract between the muscles surrounding the anus and ligation of the fistula tract. This is a novel approach with success rates around 70%.
B. ANAL FISTULA PLUG METHOD
Procedure is to seal the fistula tract through the use of fibrin glue. This method is used for selected patients with high incontinence risk for whom the seton method cannot be chosen, but the relapse rates are high. Use of bioprosthetic materials both mechanically seals the fistula and accelerates the spontaneous closure by accelerating the regeneration of the fistula tract. Short term successful results are reported in patients with complicated fistulas and perianal fistula accompanied by inflammatory intestine disease.