Fistula

Twelve years ago, this patient was diagnosed with a complex fistula in ano and underwent a colostomy, by another surgeon. This is a procedure where the stools are diverted through the abdominal wall, by creating a stoma (opening) and the stools are passed out into a bag ( colostomy bag). While this can be life-saving in some cases, it is highly inconvenient and impacts the patient’s quality of life.

Since the stools were diverted, the patient subsequently underwent surgery for repair of the fistula. After this fistula surgery, the colostomy was closed, assuming that the fistula has healed.

After the colostomy closure, the fistula recurred and the severity got worse. The physical discomfort & the anxiety were higher than ever before.

After suffering in silence for a few years, the patient went to a government hospital, which in turn referred the patient to DLPC – Dr. Laxman Salve.

This patient was operated on 5th August 2024, He had 5 external openings on right side and 2 on left side.

Right sided – 3 tracts merged together and drained into the IRF ( Ischio-Rectal Fossa) and the 4th and 5th tracts drained separately. The tract was then traversing trans sphincteric to open at 6 o clock with 1 cm wide internal opening in involving part of the puborectalis sling.

Left sided – 2 tracts merged together and drained into the IRF ( Ischio-Rectal Fossa). Left side tract was again trans sphincteric with opening at 6 o clock in the same opening as that of right sided tract with inter sphincteric extension leading to sealed off rectal perforation on left side.

We managed this patient with fistulotomy, where we opened up the tracts by cutting of sphincters along the tracts and after thorough debridement and taking the disease out completely, we did primary sphincter repair on the right side and on the left side, we kept it open partially.

With proper follow-up and post operative care, patient improved very comfortably in 2 months follow up period. We preferred to treat the patient without doing a colostomy this time.

Patient is very happy with the outcomes, is fully continent and can control and pass stools comfortably.

This surgery was done by Dr Laxman at the very nominal fees, similar to those offered by the Govt Hospital.

At DLPC, we follow modern protocols, and avoid doing colostomy, as much as possible in order to assist the patient to return to normal lifestyle and in the shortest time possible, with the least amount of pain, discomfort and social embarrassment.