A fistula is a pathological (abnormal) channel connecting the anal canal/rectum to the skin of the perineal area. Typical symptoms of this disease are leakage of purulent contents from the anal area, recurrent perianal abscesses, and itching and burning of the skin of the anal area. Periodic aggravation of the above complaints is also characteristic of this disease. When the external and internal fistula orifices become overgrown, a perianal abscess develops - a severe, painful exacerbation of the skin in the perineal area, often accompanied by fever and chills.

Description of the course of the proposed medical procedure or operation

The operation is carried out under intravenous, regional or general anaesthesia (the anaesthetist will provide detailed information on anaesthesia and its possible complications during the examination). The first stage of the procedure is a thorough inspection of the rectum and perirectal area. Once the external opening of the fistula channel has been found, the operating surgeons will try to find its internal opening and find all the fistula channels. Depending on the course of the fistula channel, a decision will be made as to the optimal type of operation. If the fistula canal runs just under the skin it can be excised in its entirety or dissected. In cases where the canal runs deeper and through the external sphincter muscle, then a thread will be inserted into the lumen of the canal, which will have to remain there for a period of several weeks to several months. In addition, part of the fistula on the skin side will be excised. In the case of more external outlets or fistula channels, more drainage threads or drains will have to be placed. In the case of deep perianal fistulas, it is sometimes necessary to place drains in the anal area (also for a period of several weeks to several months). Cases of complex (more complicated) fistulas can be treated by performing surgery to close the fistula mouths with a displaced skin or mucosal flap. The healing period for the operated areas can be very long in this disease - longer than the time shown above for leaving sutures or drains in the fistula ducts. It should also be noted that the treatment of perianal fistulas is often multistage, i.e. it is necessary to spread the individual stages of treatment over several surgical procedures.

Description of other available treatments

It should be emphasised that surgical treatment of perianal fistulas is the only form of therapy that allows the patient to be cured, but is fraught with a high rate of complications (fistula recurrence and impaired continence) - 13 to 36%. The methods outlined above are the most commonly used, with the highest treatment success rate. Other surgical treatments include closing the fistula channel with silicone plugs or sealing with a special tissue adhesive. However, these methods are only effective for the treatment of simple fistulas. There are no pharmacological methods that have been shown to be effective in treating this condition.