ANORECTAL CONDITION · CONDITION GUIDE
Anal Fistula
An abnormal tract between the anal canal and the perianal skin causing persistent discharge and recurrent abscesses — treated surgically to eradicate the tract while preserving sphincter function.
ABOUT THIS CONDITION
What is Anal Fistula?
An anal fistula is an abnormal communicating tract lined with granulation tissue between the anal canal or rectum and the perianal skin, most commonly arising from an infected anal gland (cryptoglandular theory). It presents with persistent perianal discharge, recurrent abscess formation, and localised pain or discomfort. Fistulas are classified by their relationship to the sphincter complex (intersphincteric, transsphincteric, suprasphincteric, extrasphincteric). Dr. Tagore Mohan Grandhi treats anal fistulas at Lux Hospitals, Hyderabad, using a sphincter-preserving approach wherever possible. The technique is selected based on fistula complexity, sphincter involvement, and patient continence status — ranging from fistulotomy for simple low fistulas to advanced sphincter-preserving techniques such as VAAFT, LIFT, FiLaC laser, and advancement flap for complex fistulas.
SIGNS TO WATCH
Common Symptoms
Symptoms that need attention
WHY IT HAPPENS
Causes & Risk Factors
- Infection of an anal crypt gland with abscess tracking to the perianal skin
- Crohn’s disease — a major cause of complex fistulas
- Previous anorectal surgery or trauma
- Radiation proctitis causing fistula formation
- Tuberculosis or actinomycosis in endemic areas
- Hidradenitis suppurativa in the perianal region
CLINICAL DETAILS
KeyFacts
Intersphincteric, transsphincteric, suprasphincteric
Sphincter preservation to avoid faecal incontinence
Fistulotomy — lay open with high success rate
LIFT, FiLaC, VAAFT, or advancement flap
Seton drainage and biological therapy combined
Available at Lux Hospitals, Hitech City, Hyderabad
HOW WE TREAT IT
Treatment Approach
VAAFT — Video-Assisted Anal Fistula Treatment
VAAFT uses a miniature fistuloscope to directly visualise the fistula tract from within, identify all internal openings, and ablate the tract under direct vision. Dr. Grandhi offers VAAFT as a sphincter-sparing minimally invasive treatment for complex fistulas, avoiding sphincter division and reducing recurrence.
- 1
Assessment & Fistula Mapping
Clinical examination identifies the external opening. MRI pelvis maps the fistula tract, its relationship to the sphincters, and any secondary extensions. EUS may supplement mapping.
- 2
Seton Placement (if complex)
For complex or high transsphincteric fistulas, a loose seton is placed through the tract to allow drainage, resolve sepsis, and maintain the tract while awaiting definitive repair.
- 3
Definitive Surgical Repair
Low simple fistulas are laid open (fistulotomy). Complex sphincter-involving fistulas are treated with LIFT, VAAFT, FiLaC laser ablation, or mucosal advancement flap to eradicate the tract while preserving continence.
- 4
Recovery & Wound Care
Daily sitz baths, high-fibre diet, and wound care are maintained during healing. Wound assessment at 2–4 weeks monitors healing progress. Follow-up MRI at 3 months confirms fistula closure in complex cases.
AVAILABLE TREATMENTS
TreatmentOptions
VAAFT Procedure
Video-assisted internal fistula ablation under direct endoscopic visualisation. Sphincter-sparing procedure for complex fistulas.
Fistulotomy
Surgical laying open of the fistula tract. Definitive treatment for low intersphincteric and low transsphincteric fistulas involving minimal sphincter.
Laser Fistula Treatment (FiLaC)
Laser ablation of the fistula tract using a radially emitting fibre inserted through the external opening. Minimally invasive sphincter-preserving approach.
LIFT Procedure
Ligation of the intersphincteric fistula tract via an intersphincteric approach, closing the internal opening without dividing sphincter muscle.
Seton Placement
Loose non-cutting seton drawn through the fistula tract to allow drainage of sepsis and maintain tract patency prior to definitive sphincter-preserving repair.
Advancement Flap Surgery
Mucosal or full-thickness advancement flap advanced over the internal fistula opening to close it from within. Used for complex transsphincteric fistulas.
COMMON QUESTIONS
Frequently Asked Questions
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