Complex anal fistulas
Fistulas involving multiple tracts, deep extensions, abscess cavities or significant portions of the anal sphincter muscles.
Specialised Treatment for Complex, Recurrent & Rectovaginal Fistulas
Dr. Ashwin Porwal - Anal Fistula Specialist & Colorectal Surgeon in Pune
Has your fistula returned even after surgery? Have you been told your condition is too complicated to treat?
Complex fistulas demand more than routine surgery. They demand specialised expertise.
Meet Dr. Ashwin Porwal, Founder of Healing Hands Clinic, Pune, and an experienced colorectal surgeon with over 18 years of experience and 8,500+ fistula surgeries to his credit. Recognised nationally for his work in complex and recurrent anal fistula treatment, Dr. Porwal has dedicated his surgical career to advancing the treatment of anorectal diseases, with a particular focus on conditions that are difficult to treat using conventional methods. As the Founder of Healing Hands Clinic, he has played an important role in developing proctology as a focused surgical specialty in India.
Dr. Porwal developed the innovative DLPL (Distal Laser Proximal Ligation) technique to address some of the most challenging anal fistulas. His intent was simple - the technique must carefully balance two equally important goals: achieving lasting healing and protecting normal bowel control. His areas of special interest include high complex anal fistulas, recurrent fistulas following previous surgery, and rectovaginal fistulas.
Qualifications & Professional Background
- MBBS – B.J. Medical College, Pune
- DNB (General Surgery) – Poona Hospital & Research Centre
- Specialised training in Proctology in Europe
- Diploma in Laparoscopy – EITS-IRCAD, France
- Founder – Healing Hands Clinic
What sets Dr. Porwal apart is his focus on understanding why difficult fistulas persist or recur, and developing surgical approaches to address those challenges.
Book a Consultation with Dr. Ashwin PorwalComplex & Recurrent Fistula Treatment - Dr. Porwal’s Area of Expertise
Not all anal fistulas are alike.
Some involve a short, straightforward tract. Others branch into multiple tunnels, extend deep into the tissues, or pass through important muscles surrounding the anus.
These are known as complex anal fistulas, and their treatment requires careful planning.
Dr. Porwal's surgical practice has a particular focus on:
Recurrent fistulas
Fistulas that return or fail to heal after one or more previous surgical procedures.
High anal fistulas
Fistulas involving a substantial portion of the sphincter muscles, where conventional surgery may carry a greater risk of affecting bowel control.
Horseshoe fistulas
Fistulas that extend around the anal canal, sometimes involving both sides and multiple pockets of infection.
Rectovaginal fistulas
Abnormal connections between the rectum and vagina that require a different, specialised reconstructive approach.
Why is specialist care important?
A fistula can recur if infection persists, an internal opening remains untreated, or secondary tracts and abscesses are not adequately addressed.
In difficult cases, simply removing or closing the visible fistula tract may not be enough.
A specialist for complex anal fistula treatment must understand the full extent of the disease, identify the structures involved, and plan surgery that protects the anal sphincter muscles wherever possible.
For patients who have experienced unsuccessful fistula surgeries, a fresh, detailed assessment can be an important first step.
DLPL – An Innovative Fistula Surgery Developed by Dr. Ashwin Porwal
A sphincter-preserving approach designed for complex anal fistulas
One of Dr. Porwal's notable contributions to advanced proctology surgery is the development of DLPL – Distal Laser Proximal Ligation.
Developed specifically for complex fistula-in-ano, DLPL combines laser treatment of the fistula tract with surgical management of its internal connection and associated infection.
The procedure aims to treat the disease while avoiding unnecessary division of the anal sphincter muscles.
Why does preserving the sphincter matter?
The anal sphincters are muscles that help us control the passage of gas and stool.
Some fistulas pass through these muscles. Cutting too much sphincter muscle during surgery can increase the risk of bowel-control problems, also called anal incontinence.
This is why sphincter-preserving fistula surgery is particularly important in high, complex and recurrent fistulas.
How does DLPL work?
The operation is planned after assessing the fistula's anatomy and identifying its internal opening, branching tracts and areas of infection.
Depending on the findings, the technique involves:
- Identifying the complete fistula tract and associated abscess cavities.
- Treating the internal opening and infected tissue.
- Using specialised laser energy to treat the appropriate part of the fistula tract.
- Preserving the sphincter muscles as far as the anatomy allows.
- Monitoring wound healing through planned postoperative follow-up.
The objective is not simply to close the external opening, but to achieve complete healing while maintaining normal anal function.
DLPL Clinical Study – Published Research in Anal Fistula Surgery
Dr. Ashwin Porwal published a clinical study evaluating DLPL surgery in patients with complex fistula-in-ano.
Published study findings:
- 683 patients underwent DLPL surgery.
- The reported overall success rate was 98.98%
- Minimum long-term follow-up was 30 months
- No permanent anal incontinence was reported in the study.
- Average complete healing time was approximately 10 weeks
Special Expertise in Rectovaginal Fistula Treatment
A sensitive condition that requires specialised surgical care
Rectovaginal fistula is an abnormal connection between the rectum and the vagina. It may cause gas or stool to pass through the vagina, leading to repeated infections, discomfort and considerable emotional distress.
The condition may develop following childbirth-related injuries, previous pelvic surgery, inflammatory bowel disease such as Crohn's disease, or other forms of tissue damage.
For many women, living with a rectovaginal fistula can affect confidence, relationships and everyday quality of life.
When previous rectovaginal fistula surgery has failed
A recurrent rectovaginal fistula can be particularly challenging because previous surgery may leave scar tissue or affect the blood supply to the area.
These patients benefit from detailed reassessment and an individualised surgical plan.
A carefully planned reconstructive approach
Unlike a typical anal fistula, a rectovaginal fistula usually requires surgical repair of the tissue separating the rectum and vagina.
Treatment may involve:
- Identifying the fistula opening and assessing the surrounding tissues.
- Evaluating any associated injury to the anal sphincter muscles.
- Treating infection or inflammation before definitive repair, where necessary.
- Reconstructing the affected tissues through an appropriate surgical technique.
- Repairing the sphincter muscles when indicated.
- Providing structured postoperative care and follow-up.
The exact procedure depends on the location, size and cause of the fistula, the quality of the surrounding tissue and previous surgical history. In complex cases, successful management may require staged treatment or additional procedures.
For women searching for specialised rectovaginal fistula treatment in Pune or India, Dr. Porwal and the team at Healing Hands Clinic offer evaluation and surgical care for this condition.
Request a Consultation for Rectovaginal FistulaFistula Surgeries & Treatment Options at Healing Hands Clinic
As an anal fistula surgeon, Dr. Porwal emphasises selecting treatment according to the type and complexity of the fistula rather than relying on one procedure for every patient.
Treatment options available within HHC's fistula programme include:
| Procedure | Role in treatment |
|---|---|
| DLPL – Distal Laser Proximal Ligation | Developed by Dr. Porwal for complex and recurrent anal fistulas |
| FiLaC – Fistula-tract Laser Closure | A laser-based, sphincter-sparing option for selected anal fistulas |
| Other sphincter-preserving procedures (rarely used) | Considered according to fistula anatomy, previous treatment and clinical suitability |
| Rectovaginal fistula reconstruction | Individualised surgical repair of the abnormal connection between the rectum and vagina |
Laser fistula surgery can be useful in selected patients, but laser technology alone does not determine the success of an operation. The patient's anatomy, underlying disease, quality of surgical planning and postoperative care are all important.
Why Consult Dr. Ashwin Porwal for Fistula Treatment in Pune?
Specialised surgical experience
A focused clinical interest in difficult, high and recurrent anal fistulas, including patients with previous unsuccessful operations.
Innovation backed by published research
Development of DLPL and publication of clinical outcomes involving patients with complex fistula-in-ano.
Attention to sphincter preservation
Surgical planning that considers both fistula healing and the preservation of bowel-control function.
Expertise in rectovaginal fistula repair
Experience in reconstructive approaches for a particularly sensitive and challenging condition.
Advanced diagnostic support
Access to 3D endoanal imaging and other investigations when clinically appropriate.
Continued postoperative care
Structured follow-up to monitor healing, identify complications and guide recovery.
Based in Pune, Dr. Porwal's work in complex fistula treatment has also attracted patients seeking specialised care from other parts of India and overseas.
Frequently Asked Questions
Who is an anal fistula specialist?
An anal fistula specialist is a surgeon experienced in diagnosing and treating fistulas involving the anal canal and surrounding tissues. Complex fistulas benefit from evaluation by a colorectal surgeon or proctology specialist with experience in sphincter-preserving procedures.
How do I choose the best fistula doctor in Pune?
When selecting a fistula doctor in Pune, consider the surgeon's qualifications, experience with your particular type of fistula, approach to protecting bowel control, access to appropriate diagnostic imaging, published work and arrangements for postoperative follow-up. Dr. Ashwin Porwal is a colorectal surgeon whose practice and research include complex and recurrent anal fistula treatment.
Can a recurrent fistula be treated after multiple failed surgeries?
Yes. Further treatment is possible in many cases, although surgery can become more challenging after previous procedures. An experienced recurrent fistula surgeon will reassess the anatomy, identify persistent infection and recommend an appropriate treatment plan.
Is DLPL suitable for high and horseshoe fistulas?
DLPL was developed for complex anal fistulas and may be considered in selected high, horseshoe and recurrent fistulas. Suitability must be determined after clinical examination and appropriate imaging.
Is laser fistula surgery better than conventional surgery?
Not necessarily. Laser-assisted techniques can help preserve the anal sphincter muscles in selected cases, but they are not universally superior to conventional operations. The most appropriate treatment depends on the fistula's anatomy and the patient's circumstances.
Can a rectovaginal fistula be treated without surgery?
Some small, minimally symptomatic rectovaginal fistulas may improve with careful nonoperative management, particularly in selected childbirth-related cases. Persistent or complex fistulas often require surgical repair. A specialist assessment is necessary to determine the right approach.
Can Dr. Ashwin Porwal help if another fistula surgery has failed?
Dr. Porwal's area of special expertise includes complex and recurrent fistulas. Patients with failed previous treatment can seek a specialist opinion to review their existing reports and discuss further treatment options.
Take the Next Step Towards Healing
Your fistula may be complex. Your treatment should be carefully planned.
Whether you are dealing with a newly diagnosed fistula, repeated recurrence after surgery, or a difficult rectovaginal fistula, obtaining an experienced surgical opinion can help you understand the available options.
Consult Dr. Ashwin Porwal and the specialist team at Healing Hands Clinic, Pune.
Information on this page is intended for patient education and does not replace medical consultation. The suitability, risks, benefits and expected results of surgery vary between patients.
