An anal fistula is a frustrating and often distressing condition: a small tunnel that forms near the back passage, leading to recurrent discharge, pain and swelling that never quite seems to settle. For years, the standard treatment carried a real worry, because cutting the tunnel open could risk a person’s bowel control. Modern techniques such as VAAFT and laser closure have changed this, offering effective treatment while protecting the all-important sphincter muscle.
What Is a Fistula in Ano?
A fistula in ano is an abnormal tunnel that connects the inside of the anal canal to the skin near the back passage. It usually develops after an infection in one of the small glands inside the anus, which forms an abscess. When the abscess drains, a tunnel can be left behind, and this tunnel does not heal on its own. The result is a small opening on the skin that repeatedly discharges pus or fluid, sometimes settling for a while before flaring again.
Symptoms That Suggest a Fistula
Fistulas tend to announce themselves through a recurring set of symptoms:
- Persistent or recurring discharge of pus or fluid near the back passage
- A small opening or lump in the skin that may come and go
- Pain and swelling, often worse before the fistula discharges
- Irritation of the surrounding skin
- Recurrent abscesses in the same area
The Challenge of Treating Fistulas
The difficulty with fistulas lies in their relationship to the sphincter, the ring of muscle that controls bowel movements. The traditional operation, laying open the tunnel by cutting it, works well for simple, low fistulas. But for complex fistulas that involve a significant part of the sphincter muscle, cutting through the muscle risks weakening bowel control. This is a serious quality-of-life concern, and it is why gentler, sphincter-saving techniques have become so valuable.
How VAAFT Works
VAAFT stands for video-assisted anal fistula treatment. In this technique, a tiny camera is passed into the fistula tunnel itself, allowing the surgeon to see the entire tract clearly, including any branches and the internal opening. The tunnel is then cleaned and sealed from the inside, and the internal opening is closed, all without cutting the sphincter muscle. Because the surgeon can actually see inside the tract, the chance of missing a hidden branch is reduced.
The Role of Laser Closure
Laser fistula treatment uses a fine laser fibre passed along the tunnel. The laser energy gently destroys the lining of the tract and causes it to collapse and seal, again without dividing the muscle. Like VAAFT, it is a minimally invasive, sphincter-saving approach. These techniques are often suited to complex or recurrent fistulas where protecting continence is the priority, and they can be combined with other measures depending on the individual case.
Recovery and Realistic Expectations
Sphincter-saving procedures are usually performed as daycare or short-stay surgery, with less pain and a quicker return to normal activity than wide open surgery. It is honest to say that fistulas can be stubborn, and no single technique guarantees success for every case, particularly complex ones. Sometimes more than one procedure is needed. The great advantage of these modern approaches is that they aim for healing while safeguarding bowel control, so even repeat treatment does not come at the cost of continence. A careful examination, sometimes with an MRI, helps map the fistula and plan the best approach.
Recurring discharge or abscess near the back passage?
Dr. Gautham Krishnamurthy offers sphincter-saving laser and VAAFT treatment for anal fistula at P&G Hospital, Chennai. Consultations are private and unhurried. For appointments, contact reception.