" You have really showed that the oath doctors take is indeed your first priority when it comes to patients. I am immensely grateful and blessed to have been in you care."

Shantaji Bharti

" The staff behavior, clinical advice and doctor's support was very encouraging. Patient comfort and delight is the culture at Healing Hands Clinic which is becoming rare in hospitals. "

Anant Joshi

" The moment you enter the clinic you feel at ease, stress free & get positive vibes. I pray to make Healing Hands stronger to heal many patients & continue the good work of serving mankind. "

Ismail Shaikh

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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.

Anatomy of rectum anal canal

Causes Of Fistula

  • Anorectal abcess - Almost all anal fistulas are a result of a preceding anorectal abcess. An anorectal abcess begins as an infection of one of the anal glands. The infection soon forms a pool of pus - abcess. An anal fistula results when the abcess fails to heal completely with/without treatment.
  • Conditions that cause inflammation of the intestines like Crohn's disease, Diverticulitis.
  • Malignancy in the anorectal region.
  • Infections - Tuberculosis, HIV, sexually transmitted diseases
  • Iatrogenic - As a complication of a previous surgery in the region.

Symptoms Of Fistula

  • Throbbing pain that worsens on sitting

  • Swelling, tenderness, itching or redness around the anus

  • Discharge of pus, blood and debris which is usually foul smelling

  • Pain associated with bowel movements

  • Fever

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.

Treatment for fistula

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.

Advantages of FiLaC

  • It has an excellent healing rate as compared to all other techniques.
  • The anal sphincter is preserved so there is no risk of post-operative incontinence.
  • It can be done in complicated fistulas like recto-inguinal, recto-gluteal fistulas.
  • It is safe in high risk patients like those with hypertension, cardiac ( heart ) problems and in senior citizens.

Potential drawbacks of FiLaC

  • There may be local burning for some time
  • Post-operative subcutaneous abcess : It is usually managed with medications and dressing.
  • In rare cases it may need incision and drainage under local anaesthesia.

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.



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