What is anal fistula?
Anal fistula refers to a fistula that communicates with the anal canal or rectal cavity. Anal fistula is formed after the ulceration of an abscess around the anorectal. One end of the fistula leads to the infection foci of the anal gland in the anal canal, called the internal opening; the other end leads to the skin around the anus, called the external opening.
The formation of anal fistula is the inevitable result of the development of infection around the anorectum. The formation of anal fistula roughly goes through four stages: from infection and inflammation of the anal crypt, to inflammation of the anorectum, then to abscess around the anorectum, and finally the abscess self-ulceration or incision drainage Later, an anal fistula formed. In fact, just like we usually blow a balloon, we start to blow the air until the balloon is big, and finally the balloon bursts. Therefore, the key to treatment is to find the root of the disease-the opening for blowing the balloon.
2. Why does anal fistula need surgery?
If the disease of anal fistula is allowed to develop, not only will it not heal itself, it may become more and more serious. Because if the internal mouth of anal fistula cannot be treated, there will be a steady stream of dirt entering the fistula tract, so it is difficult for the anal fistula to heal itself. With repeated infections, a simple anal fistula may become complicated. This will increase the pain of the patient during treatment, increase the difficulty of treatment, and reduce the cure rate. Therefore, we believe that anal fistula should be treated as soon as possible.
3. Progress in surgical treatment of anal fistula
At present, the treatment of anal fistula in China is mainly based on Chinese medicine. There are two main types: fistula incision and thread hanging. Because perianal abscess and anal fistula may spread in all directions along the interstitial space, if the fistula branches, the omission of the branch fistula and infection during the operation will inevitably lead to recurrence. After surgery, the incision is generally open. The trauma of these treatments is relatively large, and the pain is correspondingly greater. Especially for thread-hanging therapy, most of them use rubber bands for thread-hanging. The purpose is to protect the anal sphincter function through chronic cutting, but the pain is great. Refined surgery can reduce pain and damage to anal function to a certain extent. And what we are currently mainly developing is the most advanced video-assisted anal fistula treatment (VAAFT) in the world, commonly known as "anal fistulascopy", which is directly operated in the fistula, walking along the fistula to the inner mouth, avoiding the anal sphincter and surrounding areas. Soft tissues are truly minimally invasive surgery. From this, we can see that the progress of the treatment of anal fistula is from severe trauma to small trauma, from advocating cure rate to better protection of anal function at the same time, and further, minimally invasive surgery that hardly damages the sphincter and soft tissue.
4. How to perform precise treatment of anal fistula?
Because anal fistula is a disease with many changes, the location of the external opening is not fixed, and there are multiple external openings, the direction of the fistula is not fixed, and the position and number of the internal openings are also different. Therefore, the treatment of anal fistula cannot be done in a modular operation like hemorrhoids and anal fissures. Therefore, according to different conditions, patients with anal fistula need precise treatment; precise treatment should be based on precise diagnosis.
We suggest that complicated anal fistulas must be examined and evaluated in detail before surgery. At present, we routinely perform MRI examinations for anal fistulas, color Doppler ultrasound in the anorectal cavity, and anorectal pressure measurement to accurately assess the condition of complex anal fistulas and anal function before surgery.
If the fistula is very shallow and short, we can do routine surgery directly. On the one hand, it is unnecessary to use an anal fistula for this type of anal fistula. On the other hand, the operation of anal fistula requires a certain amount of space, and a too short fistula will also cause the anal fistula to be unable to perform normal operations. Anal fistula scopes are good at complex anal fistulas. Those high-level and longer fistulas may have anal fistulas with hidden branches.
Moreover, if you encounter different situations during the operation of anal fistula, you can also perform a combination of multiple surgical methods for treatment. For example, if the inner orifice is closed, we can treat it according to the infectious sinus. If the inner orifice is wide, and when the risk of suturing the inner orifice is high, we can also move the mucosal flap. The local scar of the inner orifice is obvious. You can also hang the line nearby, and do drainage from the outside.
5. What should be paid attention to after anal fistula operation?
In fact, after anal fistula endoscopic surgery, the wound basically does not require special treatment. But there are still some precautions. First of all, we should pay attention to whether there is any redness and swelling of the perianal soft tissue after the operation and the drainage of the wound, which can indicate whether there is a postoperative infection in the fistula. The second is to prevent diarrhea and constipation, which may be infected with the closed inner mouth. In addition, it is important to ensure adequate sleep and improve self-immunity for postoperative recovery. Finally, healthy eating habits, avoiding spicy irritation and drinking alcohol can also help recovery after surgery.