Fistula and the Best Treatment Options - Fistulectomy

What is Fistula?

A Fistula is like a tunnel or a tract that connects two organs, blood vessels, skin, or any other structure that are usually not connected. A fistula may occur due to an injury, surgery, inflammation, and, although rare, naturally.

Where can Fistulas Form?

Fistulas can occur between any two organs, such as

• Between an artery and a vein (Arteriovenous Fistula)
• Between an artery and a vein in the lungs (Pulmonary Arteriovenous Fistula)
• Between bile ducts and the nearby hollow structures (Biliary Fistula)
• Between the vagina and the nearby organs like the bladder, ureter, urethras, rectum, colon, and small intestine (Vaginal Fistula)
• Between neck and throat (Chylous Fistula)
• Between the skull and nasal sinus
• Between anus and surface of the skin (Anorectal Fistula)
• Between stomach/intestines and the surface of the skin (enterocutaneous fistula)
• Uterus and peritoneal cavity (Metro peritoneal Fistula)
• Between the gut and naval (Gastrointestinal Fistula)

What are the major types of Fistulas?

Among the various types of Fistulas, the below mentioned are common.

1. Anal Fistula
2. Vaginal Fistula
3. Gastrointestinal Fistula

Anal Fistulas

An anal fistula or an Anorectal Fistula occurs when an abnormal connection is formed between the anal canal (part connecting the anus to the rectum) and the skin surrounding the anus. This is caused by an anal infection. The anal infection causes pus to collect in that area. When the pus drains, a fistula is formed between the anal canal and the surrounding skin.

Vaginal Fistula

A vaginal fistula occurs when there is an abnormal connection between the vagina and the nearby organs such as the bladder, ureters, urethra, rectum, colon and small intestine.

The major cause of vaginal fistula is surgery in the area. However, bowel diseases and traumatic injuries due to accidents are also major causes.

Gastrointestinal Fistula

A gastrointestinal fistula occurs due to an abnormal connection from the stomach or the intestines to a nearby organ, leading to a leak. Fistulas can form between the gut and various parts.

• Entero-enteral fistulas connect the stomach and the intestines and cause leakage in the intestines,
• Enterocutaneous fistulas connect the stomach or intestines to the skin tissues and cause the leakage to go through the skin.
• Vagina, anus, colon, and bladder might also be involved.

Diagnosis of Fistulas

First, the patient has to be properly diagnosed by examination under anaesthesia to locate and determine the severity of the fistula. The external opening, internal opening, and the tract are identified. Based on the severity, it is classified into:

• Low-level fistula
• High-level fistula

After classification, treatment options are prescribed.

Treatment options for Fistulas

The most common type of fistula is the anal fistula. Sometimes depending on the severity, the surgeons prescribe various treatment options. Some of the treatment options are

Non-Invasive Treatment Options

• Antibiotics
• Immune Suppressant medication (If the fistula is due to Crohn’s disease)
• Fibrin Glue
• Plug

Invasive Treatment options

• Transabdominal Surgery
• Laparoscopic Surgery

Fistulotomy

If the patient is diagnosed with a low-level fistula, then a Fistulotomy is prescribed. Fistulotomy is a surgical procedure where the surgeon makes an incision in the affected region and severs the abnormal connection between the two organs.

This procedure only severs the tract, it does not remove any tissue. The two organs will have tissues attached to them, but they are now separate and can move and function freely. This is not a complicated procedure and requires only minimal invasion.

Fistulectomy

In contrast to Fistulotomy, which only severs the connection, Fistulectomy removes the entire tract. If the patient is diagnosed with a high-level fistula, then Fistulectomy is preferred. This is a more invasive procedure but is required in cases where there is a large mass of tissues. It prevents the relapse of the fistula. It has a higher recovery period than Fistulotomy but is considered more effective.

The procedure is done in patients suffering from high-level anal fistulas. Fistulectomy is also said to cure the fistula permanently and other chronic anal diseases. In other forms of treatment, fistulas are likely to relapse.

How is Fistulectomy done?

• The Fistulectomy procedure is done under general or spinal anaesthesia
• A contrast dye is injected into the external opening
• An imaging technique such as an X-Ray or MRI is used to highlight the full fistula tract
• The surgeon removes all the three parts – internal opening, external opening, and the tract of the fistula
• Care is taken to keep the sphincter muscle intact

The procedure lasts for about 45 minutes to 1 hour and is performed as an outpatient surgery. It takes about 4 to 5 hours for the effects of anaesthesia to wear out. Unless there are any complications, the patient is discharged the same day after the minimum observation period.

Recovery after a Fistulectomy Procedure

After the Fistulectomy procedure, the patient is discharged the same day, provided there are no complications. The person can return to work after 2 weeks of rest. But, it takes around 4 to 6 weeks for the body to heal completely.

This procedure involves medium to large incisions. So, for home care after surgery, the surgeon prescribes painkillers, antibiotics and post-surgical instructions to follow.

Conclusion

Fistulas can develop between any two organs of the body. This article highlights the most commonly caused fistulas and their treatment options. Fistulas rarely get cured on their own without medical intervention. It can highly affect the living standards of the patient. So, it is necessary for people exhibiting the above-said symptoms to consult a doctor.

Call 1800 500 2244 for an appointment. Visit a specialist at your nearest Apollo Spectra Hospitals