An anal fistula is a tract connecting the inside of anal canal (back passage) and the skin.

Commonly anal fistula results from an abscess that has either spontaneously drained through the skin or drained surgically.

A small percentage of patients may present with a fistula without a history of abscess.

There are different types of anal fistula, depending on the route of the communication tract.

A patient with an abscess typically present with pain and swelling. There may also be associated fever and feeling generally unwell.

A patient with fistula will have ongoing discharge from an opening in the skin. This may be bloodied, pussy or faecal stained.

A patient may require a MRI examination of the area to define the fistula anatomy.

A patient with an abscess will require that the abscess be drained as an emergency.

The management of an anal fistula will depend on whether the sphincter muscle is involved.

Options include:

In this method, the communicating tract is filled with a mesh plug or surgical glue.

This is a new method, where the fistula tract is visualised and inspected using a small rod-shaped camera (video-scoped).

The tract is then cleaned and mesh plug or glue placed into the tract.
 

See more details about VAAFT here.

The complications are heavily influenced by the complexity of the fistula disease, the extent of the sphincter muscle involvement and the nature of the surgery.

In general, the complications include the following and will be discussed in more detail during the consultation:

• Bleeding (haematoma)
• Wound infection
• Incontinence – this risk may occur when the sphincter muscle is damaged. The risk will depend on the type of procedure being performed.
• Recurrence – The recurrence rate will depend on the complexity of the disease and the type of procedure performed.

This depends on the type of procedure being performed.

It varies from a few days of post-operative time off for VAAFT with minimal dressing requirement to regular outpatient dressing requirement with a fistulectomy. A seton placement procedure will require a number of planned operative visits.