Comprehensive Guide to Fistula Surgery in Singapore

Introduction to Fistula Surgery

• Anal fistula are "tunnels" that connect the skin surface around the anal margin to the anal canal. These tunnels can be of varying length and involve the anal sphincter muscle. Untreated, when the tunnels become infected, this can result in repeated inflammation and infection in the fatty tissue surrounding the anus. There will usually be pain and purulent discharge during these periods. Solving the problem requires accurate identification of the origin and termination of these tunnels. Endoanal ultrasound and MRI ( magnetic resonance imaging) allow accurate diagnosis and mapping.
• Anal fistula usually begins with the infection of oil-secreting glands in the distal part of the anal canal. The pores of these glands can be blocked and thus lead to pus (abscess) formation. At this stage, the patient would present with a painful boil in the buttock region. The boil usually spontaneously discharges to the skin surface. Alternatively, surgical drainage of the boil would usually lead to an external opening as the source of the pus was from an internal opening in the anal canal. This internal opening feeds into the external opening, preventing its natural closure. Surgical techniques are geared towards disconnecting the internal opening from the fistula track or “Laying open” the track and allowing natural healing. The latter choice can only be made if the fistula is shallow; if too much muscle-controlling continence is cut, the patient could become incontinent to gas and fecal material, or both.

Understanding Fistula Surgery

• One of the main problems facing surgery is the involvement of the anal sphincter. If too much sphincter muscle is cut, problems with continence could arise. If a large extent is involved, then a staged procedure requiring the use of an inert drain may be required - "seton." Otherwise, laying open the fistula in low openings results in the best cure. An advancement flap is another technique used to raise a flap of intestine lining to cover over the internal opening of the track, thereby disconnecting the communication to the track. Other novel techniques currently employed include VAAFT (Video Assisted Anal Fistula Treatment) or LIFT (Ligation of Fistula Tract)
• Some rare conditions can also occur in anal fistula formation. Crohn’s disease is a chronic inflammatory bowel disease that will not heal without the use of specialized medicine. Anal cancer may also sometimes be the cause. It is essential to seek medical help early to prevent the condition from becoming chronic.

Conclusion: Prioritizing Wellness with Fistula Surgery

• The benefits of undergoing fistula surgery are mainly to stop the ongoing discharge of pus and fecal material through the external openings. Also, recurrent infections could lead to more separate openings developing. This would make subsequent therapy even more difficult. Complex fistula may require staged procedures, and the recurrence rate is high without proper preoperative imaging that would demonstrate the track's configuration like a road map.