Fistula Surgery Specialist in Pune

Minimally invasive VAAFT, laser, and surgical treatment options

What is an Anal Fistula?

An anal fistula is an abnormal tunnel or tract that connects the anal canal (inside) to the skin near the anus (outside). It typically develops from an infected anal gland and usually causes drainage, pain, and recurrent infections.

Unlike external hemorrhoids or simple abscesses, fistulas require surgical treatment for complete healing and to prevent complications.

Types of Anal Fistulas

Intersphincteric Fistula (45%)

Tract lies between internal and external sphincter muscles. Simplest type with best prognosis.

Transsphincteric Fistula (30%)

Tract crosses both sphincter muscles. Requires careful treatment to preserve continence.

Suprasphincteric Fistula (20%)

Tract goes above sphincter complex. More complex, requires specialized techniques.

Extrasphincteric Fistula (5%)

Tract bypasses sphincter complex. Usually associated with IBD or trauma.

Symptoms of Fistula

Primary Symptoms

Persistent drainage or pus
Pain or discomfort in anal area
Itching around anus
Swelling and redness
Visible opening near anus

Secondary Issues

Recurrent abscess formation
Fever during acute flares
Difficulty sitting
Skin irritation and chafing
Fecal soiling of underwear

Causes of Fistula

Anal Gland Infection (90%): Most common cause, starts as abscess then drains
Inflammatory Bowel Disease: Crohn's disease significantly increases risk
Trauma: Childbirth, surgery, or anal trauma
Chronic Inflammation: Long-standing irritation or infection
Radiation Therapy: Previous rectal radiation
Tuberculosis: Rare in developed countries but important to exclude

Diagnosis of Fistula

Clinical Examination

Visual inspection and digital examination to identify external opening and tract direction.

Anoscopy

Visualization of internal opening using specialized scope.

MRI Imaging

Gold standard for complex fistulas. Shows exact tract anatomy and sphincter involvement.

Ultrasound

3D ultrasound can identify tract and classify fistula type.

Treatment Options for Fistula

1. VAAFT (Video-Assisted Anal Fistula Treatment)

Minimally invasive endoscopic technique. Identifies tract, ablates lining, and closes opening. High success (85-95%), minimal recovery.

2. Laser Fistulotomy

Laser vaporizes fistula tract. Less invasive than traditional surgery. Good for simple fistulas.

3. Traditional Fistulotomy

Surgical division of fistula tract. Gold standard for simple fistulas. Higher bleeding risk but proven technique.

4. Seton Placement

Elastic cord placed through tract. Allows gradual healing over 12 weeks. Used for complex fistulas.

Recovery After Fistula Treatment

VAAFT Recovery: 2-3 weeks. Minimal pain, return to work in 3-5 days.

Laser Treatment: 2-4 weeks. Less invasive, rapid healing, minimal scarring.

Traditional Fistulotomy: 4-6 weeks. Complete healing takes time, requires good hygiene.

Seton Placement: 12 weeks gradual drainage, then follow-up procedure if needed.

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Dr Kundan Kharde specializes in complex fistula cases with VAAFT technology.

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Other Treatments Available

Piles Treatment

Fissure Treatment

Hernia Surgery

Anal Fistula: What Patients Should Know

A fistula is an abnormal tract connecting the anal canal to perianal skin, often after an abscess. Symptoms include discharge, pain, and recurrent swelling. Treatment aims to drain infection, define the tract, and minimise sphincter injury—options include fistulotomy, seton, VAAFT, or laser-assisted approaches depending on complexity.

Evaluation

Examination may be supplemented by MRI or endoanal ultrasound in complex cases. The goal is accurate mapping before surgery.

Recovery and follow-up

Wound care and hygiene reduce recurrence risk. Long-term outcomes depend on tract anatomy, underlying conditions (e.g., Crohn’s), and adherence to follow-up.

Frequently Asked Questions

What is an anal fistula?

An anal fistula is an abnormal tunnel connecting the anal canal to the skin near the anus, usually resulting from an infected anal gland.

What causes anal fistulas?

Most commonly caused by abscess drainage. Other causes include inflammatory bowel disease, trauma, or chronic inflammation.

What are the types of anal fistulas?

Types include intersphincteric, transsphincteric, extrasphincteric, and suprasphincteric based on their relationship to anal sphincter muscles.

Is fistula treatment surgery required?

Yes, antibiotics alone cannot cure fistulas. Surgery is necessary for complete healing and to prevent recurrence.

What is VAAFT surgery?

VAAFT (Video-Assisted Anal Fistula Treatment) is a minimally invasive endoscopic technique with high success rates and minimal complications.

How long is recovery after fistula surgery?

Recovery varies by type: traditional fistulotomy (4-6 weeks), VAAFT (2-3 weeks), seton placement (12 weeks with gradual drainage).

What are the risks of fistula surgery?

Risks include recurrence (5-15%), infection, bleeding, and rare sphincter damage. Complication rates are low with experienced surgeons.

Can fistulas come back after treatment?

Recurrence rates range from 5-15% depending on fistula type and surgical technique. VAAFT has lower recurrence rates.

This procedure is performed at Sharvari Hospital

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