The Procedure
What is DLPL?
DLPL — Distal Ligation with Proximal Laser — is a
proprietary surgical technique for fistula-in-ano developed by Dr. Ashwin Porwal at Healing Hands Clinic.
It represents the most significant advance in fistula surgery in India in the past two decades.
Traditional fistula surgery (fistulotomy) requires cutting
the sphincter muscle to lay open the fistula tract, which carries a risk of incontinence. Newer
sphincter-sparing techniques like VAAFT and LIFT preserve the sphincter but have limited efficacy for
complex or high-level fistula. DLPL solves both problems simultaneously.
In DLPL, the distal (lower) portion of the fistula tract is ligated at the internal
opening (sphincter-preserving), while the proximal (upper) tract is precisely obliterated using a diode
laser. This combination achieves complete fistula closure with no sphincter damage and a very low
recurrence rate — even in the most complex cases.
How DLPL Works — Step by Step
1
Pre-operative Assessment
MRI fistulogram + anorectal manometry to map the fistula tract anatomy
precisely before surgery.
2
Anaesthesia
Spinal or general anaesthesia. Procedure typically takes 45–75 minutes
depending on complexity.
3
Distal Ligation
The distal fistula tract is ligated at the internal sphincter opening —
precisely, without cutting any muscle.
4
Proximal Laser Obliteration
A precision diode laser fibre is passed through the proximal tract and
activated to ablate the entire tract lining from inside out.
5
Recovery
Most patients are discharged the same day or the next morning. Outpatient
follow-up at 1 week, 1 month, and 3 months.
Clinical Outcomes
DLPL Results at Healing Hands Clinic
Based on HHC's published clinical experience across the network:
95%+
Fistula Closure Rate
Same Day
Discharge (Most Cases)
How DLPL Compares
DLPL vs. Other Fistula Techniques
| Factor |
DLPL (HHC) |
Conventional Fistulotomy |
VAAFT |
LIFT |
| Sphincter preserved? |
✓ Fully |
✗ Muscle cut |
✓ (limited) |
✓ (limited) |
| Suitable for complex fistula? |
✓ Yes — all grades |
✗ High risk |
✗ Limited |
✗ Limited |
| Continence risk |
✓ None |
⚠ 5–30% risk |
✓ Low |
✓ Low |
| Recurrence risk |
✓ Very low (<5%) |
⚠ 15–25% |
⚠ 15–30% |
⚠ 20–35% |
| Recovery time |
✓ 5–7 days |
✗ 4–6 weeks |
✓ 5–10 days |
✓ 7–14 days |
| Available in Nashik |
✓ HHC College Road only |
✓ Widely |
✓ Limited |
✓ Limited |
Is DLPL Right for You?
Ideal Candidates for DLPL in Nashik
DLPL is particularly suitable for patients with the following
presentations:
🔄
Recurrent Fistula
Failed conventional surgery once or twice — DLPL addresses the root cause using a
different anatomical approach.
⬆️
High-Level (Suprasphincteric) Fistula
The fistula tract passes high through or above the sphincter complex — conventional
surgery would cause incontinence.
🔀
Complex Multi-Tract Fistula
Horseshoe fistula or branching tracts that are difficult to address comprehensively
with single-technique approaches.
👤
Patients Prioritising Continence
Anyone for whom preserving normal bowel continence is a priority — DLPL carries zero
sphincter-damage risk.
💊
Crohn's-Associated Fistula
Fistula in patients with Crohn's disease — DLPL's gentle tissue handling and
sphincter preservation makes it suitable.
⏱
Fast Return to Work Needed
Professionals or active individuals who need to minimise downtime — DLPL's 5–7 day
recovery is significantly shorter than conventional surgery.
Patient Success Stories
What Our Nashik Patients Say
Discover how DLPL surgery at Healing Hands Clinic
transformed the lives of patients suffering from complex fistulas in Nashik.
"I went to Healing Hands Clinic for my fistula and was really pleased with the experience. Dr. Swapnil and the team gave me excellent care. The treatment was advanced and I noticed a faster recovery. Truly grateful for the expert care in Nashik."
S
Swapnil Patil
Treated at Nashik Center
★★★★★
"I visited Healing Hands Clinic for a fistula. It hadn't been long, but I found the team very good. They took their time to listen to me and told me what I needed to know. The staff was nice and the clinic felt clean and calm."
S
Sanjay Sandage
Treated at Nashik Center
★★★★★
"I had a great experience at the healing hands clinic, I was diagnosed with a fistula and suggested surgery asap. I was in immense pain due to fistula. The doctors are one of the finest for treating fistula. I would recommend them to anyone."
V
Vaibhav C.
Treated at Nashik Center
★★★★★
FAQ
DLPL Fistula Surgery — Frequently Asked Questions
Is
DLPL available in Nashik?
Yes. DLPL is available exclusively at Healing Hands Clinic College Road, Nashik. As a
proprietary procedure developed by Dr. Ashwin Porwal, DLPL is only performed by HHC-trained surgeons
following the network's standardised protocol.
How
is DLPL different from VAAFT?
VAAFT (Video Assisted Anal Fistula Treatment) uses video guidance and laser to obliterate
the tract but does not address the internal opening with ligation. DLPL combines distal ligation at the
internal opening with proximal laser obliteration — making it more effective for complex, high-level fistula
where VAAFT alone has limited efficacy.
I've already had two fistula surgeries. Can DLPL still help me?
Yes — DLPL is particularly effective for recurrent fistula. The technique addresses the
fistula tract from a different anatomical approach than conventional fistulotomy or seton surgery, making it
suitable even after multiple failed prior surgeries. A pre-operative MRI fistulogram will confirm if you are
a DLPL candidate.
What is the cost of DLPL surgery in Nashik?
DLPL cost depends on the complexity of the fistula tract and whether it is a primary or
recurrent case. Insurance coverage depends on your policy. Please contact our Nashik team for a cost
estimate after a consultation and MRI review.
How
long is recovery after DLPL?
Most patients are discharged the same day or the following morning. Light work can typically
be resumed by Day 5–7. Full physical activity (gym, heavy lifting) is usually permitted from Week 4 onwards,
subject to the surgeon's assessment at the follow-up visit.
