Dr Deepak Varma Gastro Surgeon Cochin

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Anal Fistula

Also known as anorectal fistula, a fistula in anus occurs spontaneously as a hollow cavity lined with granulation tissue. Cryptoglandular infections leading to perirectal abscesses are considered as the predominant cause of anorectal fistula. The resultant is an abnormal communication between the perianal skin and the anus. Anorectal fistulas can significantly affect the quality of life of an individual.

Other Causes

  • Trauma due to rectal foreign bodies
  • Anal fissures
  • Crohn s disease
  • Carcinoma
  • Actinomycoses
  • Lymphogranulomavenereum
  • Tuberculosis

Signs And Symptoms

  • Perianal pain and discharge
  • If associated with other diseases;
  • Abdominal pain
  • Change in bowel movements
  • Weight loss


  • Classification according to Park's system: intersphincteric, transsphincteric, suprasphincteric, extrasphincteric
  • Physical exam: pain, perianal drainage, bleeding, swelling, diarrhoea, excoriation of the skin, external opening
  • Imaging:
  • Fistulography: lateral, anteroposterior and oblique images to profile the track of the fistula tract
  • Endorectal ultrasonography : using 7 10 MHz ultrasound transducer to check for a difference between transsphincteric and intersphincteric lesions; for evaluation of the rectal wall a standard water-filled balloon transducer is used
  • MRI: to study complex fistulas
  • Anal manometry: assess pressure of the sphincter mechanism
  • Digital rectal examination: Anoscopy and DRE with general anaesthesia to check the egress of the dentate line
  • Proctosigmoidoscopy: A rigid sigmoidoscopy or colonoscopy to rule out any associated disease of the rectum


For patients experiencing recurrent anorectal sepsis, therapeutic intervention is prescribed. Open fistulotomy is done for intersphincteric, low transsphincteric and primary submucosal fistulas. Seton placement is a technique that is combined with fistulotomy. For patients with chronic high fistula a mucosal advancement flap is done. Careful Surgical intervention is needed for Crohn s disease of the perineum associated with complex and multiple fistulas.

We are pioneers in intricate surgeries such as the fistula in the anus.

Authored by Dr. Deepak Varma, MBBS, MS (General Surgery)

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