It is an infection of the anal gland which leads to a perianal abscess and next can lead to a anal fistula, which is a small tunnel from the anus to the perianal skin. In case of an anal abscess this is treated by surgical incision drainage of the abscess, which cures the problem. However, in 50% of these cases an anal fistula remains. The anal fistula is treated by surgical opening of this tract (fistulotomy) when the fistula is superficial. In case of a deeper fistula (including more than 1/3 of the external anal sphincter) the fistula is treated by placement of a rubber band (seton) in the fistula in order to drain the infection and let it be cooled down for 6 weeks, after which a LIFT procedure is done, which is a surgical procedure in which the fistula is ligated and transected in between the internal and external sphincter. In some cases high up the repair is done by mucosa advancement plasty.

Causes

Mostly non-specific cryptoglandular infection (90%), specific infection (TBC, actinomycosis, lymphogranuloma venereum), IBD (Crohn’s disease), trauma or Foreign body or Surgery (episiotomy, hemorrhoidectomy, prostatectomy), malignancy (carcinoma, lymphoma, radiation related)

Symptoms

In case of an anal abscess: Severe constant pain: worse with movement & pressure (sneezing, coughing, abdominal pressure), Swelling, fever chills, additional symptoms in In very high anal abscesses (Supralevator abscess) there can be gluteal pain, constipation, urine retention.

In case of an anal fistula: pain (in case of an abscess), discharge of pus or blood, iitching (pruritus ani).

Diagnostics

MRI in case of complex or recurrent anal fistula.

Treatment

Incision and drainage in case of an anal abscess.

In an anal fistula a lay-open (fistulotomy) is done in case of a superficial fistula, and in case of a deeper fistulas seton drain placement is performed followed after 6 weeks by an mucosa advancement plasty or LIFT procedure.

Risks of the surgery

Recurrence of anal abscess or fistula, bleeding, fecal incontinence.

Why chose Professor Guido Mannaerts MD PhD

Is a Netherlands double board certified gastrointestinal and oncological surgeon with who is dedicated to minimal scar incision surgical approaches.
As being an Adjunct Professor at the UAE University and a broad research background Professor Guido is aiming for state of the art surgical care using the latest techniques.
His pleasant, honest, patient-centred care and being committed to achieve the best results for you makes you feel being treated like a family expert.