By Dr Ananya Mandal, MD
The treatment of fistulas requires surgery to correct the abnormal connection or passageway that has formed between two organs or vessels. One common complication of fistulas is infection, which needs to combated using an appropriate antibiotics. Treatment ultimately depends on the type of fistula and the associated risks and symptoms.
Typically, the treatment approach to fistulas involves:
Detailed examination of the fistula to determine the path it takes through tissue.
Special contrast dyes or imaging studies may be used to help delineate the path of the fistula. The exact pathway of the fistula and the area it opens into helps clarify the type of treatment required. For example, a blind or incomplete fistula may be treated differently than a complete fistula.
For the period inbetween the discovery of a fistula and surgery being performed to correct it, a temporary fix in the form of a prosthetic may be used such as the palatal obturator used to occlude a cleft palate for example.
An important first step in surgery is to drain any pus or infected material that has accumulated in the fistula.
The surgical removal of a fistula is called fistulotomy and is used in 85% to 95% of cases. The procedure involves removal of the fistula and the use of a seton stitch. This stitch is created by running a cord through the fistula to create a loop that joins up outside it, creating a path for drainage. The entire length of the fistula is cut through and opened out so the contents can be removed and the fistula flattened out. The fistula is then held in the new position while it heals.
An example of an alternative to the seton stitch is the endorectal flap procedure used in the case of rectal fistulas. This involves pulling healthy tissue over the inside of the fistula to prevent feces and other material from re-infecting the channel. The use of fibrin glue to fill the fistula or plugs made from biomaterial has also been explored.
Reviewed by Sally Robertson, BSc