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A fistula is a tract communicating between two epithelial lined surfaces. It can be internal or external fistula, high or low and simple or complex. It usually presents with pain, irritation and pus or watery discharge from the external opening present on the perianal skin. It is formed as a result of an infection or abscess originating in an anal gland which ruptures outside leading to communication between the abscess cavity and the skin by means of a tract or tunnel.

The diagnosis is confirmed by physical examination and will reveal an external opening near the anal verge. The opening might extrude some watery or purulent discharge. Digital examination may reveal the presence of a tract presence beneath the skin going upwards and deep into the anal canal. The internal opening may be visualised with the help of a proctoscope. The diagnosis may also be confirmed with the help of a trans-rectal ultrasound or a MRI of the perianal area. This can reveal the entire fistula tract and its course through the sphincter muscles and can help with the decision making during operation.

The treatment for any fistula is usually surgical. The type of operation depends upon whether the fistula is simple or complex and whether it is a low fistula or going deeper into the anal canal. The surgery is an open operation and involves either laying open the fistula tract or removing it completely by dissecting it from the surrounding tissues. The wound is left open to heal by secondary intention and the patient is prescribed antibiotics and painkillers along with regular sitz baths and stool softeners. Sometimes, the surgery can be done by means of a laser fibre or endoscope when the tract is superficially located. In case the fistula opens high up in the rectum or is complicated, it requires a staged operation.

The surgery is done under regional or general anaesthesia and the patient can be discharged the next day. They require rest for a period of 2-3 weeks till the wound is completely healed.

Estimate Surgery Cost

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