About Fistula

An anal fistula ( Bhagandar / Fistula in ano ) is a small channel that develops between the end of the bowel and the skin around the anus. It frequently is the result of a previous or current anal abscess. Fistula has a tract with two openings – Internal opening into the rectum or anal canal and External opening through the skin of the buttocks.

Diagnosis Of Fistula

Usually a brief history followed by clinical evaluation - including a digital rectal examination is enough to diagnose an anal fistula. At the same time Proctoscopy ( a minor inspection of the rectum using a small tube like scope ) is also done to check for any concomitant condition in the rectum.
An MRI Fistulogram may be needed for complicated fistulas in which the tract is difficult to delineate. Fistulography, an X-Ray of the fistula after injecting a contrast solution is not done any longer as it may lead to the formation of a false tract due to forceful injection of the dye.

Why get your fistula ( Bhagandar ) treated at Healing Hands Clinic?

  Being a 'Proctosurgeon', Dr. Ashwin Porwal has treated a large number of fistula cases. His expertise is evident from the fact that he has efficiently managed extremely difficult cases of Complex fistulas and Recurrent fistulas ( those that have been unsuccessfully operated upon before ). He has successfully cured rare cases of fistula, like those extending from rectum to abdomen ( Recto-abdominal ), rectum to groin ( Recto-inguinal ), rectum to tailbone ( Recto-nidal ).

  Giving an impetus to the existing armamentarium for treating fistulas, Dr. Porwal has introduced the Laser surgery FiLaC ( Fistula-tract Laser Closure ), the first of its kind in India. His keenness in research and continual lookout for progress enabled him to devise a treatment he has labelled Distal Laser Proximal Ligation ( DLPL ) . This treatment is an innovation of Dr. Porwal himself and is a sphincter-saving procedure with negligible recurrence rate compared to all other techniques.

FiLaC ( Fistula-tract Laser Closure )

This procedure, done using the Leonardo Laser, was first introduced in India by Dr. Ashwin Porwal at Healing Hands Clinic. The aim of the procedure is to gently remove the fistula tract without damaging the sphincter muscle.

The procedure is done under short General Anaesthesia and requires about 30-40 minutes. A radially emitting Laser Fibre is inserted from the outside. A defined amount of laser energy is then emitted circumferentially into the fistula tract. The laser energy causes controlled photothermal destruction of the fistula tract causing it to collapse to a high degree. This also helps supports and accelerates the healing process.

Distal Laser Proximal Ligation ( DLPL )

Fistula is a complex disease. Ultimately the aim of any fistula treatment is not just to get rid of the existing fistula but:

• 1. To save the sphincter muscle and thus prevent incontinence.
• 2. To prevent recurrence, considering the nature of the disease

   Most of the techniques like VAAFT, LIFT, FiLaC achieve the primary purpose of closing the fistula and saving the sphincter. However they all have a their own rates of recurrence. Considering how bothersome a fistula is, even a small chance of recurrence can be a concern for the patient.

   Dr. Ashwin Porwal, having specialised in Proctology ( a branch of surgery which deals with the rectum and gluteal region), has treated a large number of Fistula cases. In his experience of treating fistula patients over the past years, he tried to understand the nature of the disease and the cause of recurrences. After an in-depth study and applying all his knowledge and skills, he devised a technique he has labelled DLPL - Distal Laser Proximal Ligation.

   In this procedure any abcess cavity along with the internal opening is first excised. This is followed by closure of the distal tract. The proximal part of the fistula tract is then sealed with the Leonardo Laser. With the radially emitting fibre of the laser, energy is applied circumferentially to the fistula tract. This ensures complete closure of the tract.

IN HIS SERIES OF 100 PATIENTS WITH COMPLEX HIGH FISTULAS TREATED WITH DLPL, THERE WAS NOT A SINGLE CASE OF RECURRENCE OR INCONTINENCE.

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