Treatment of anal fistulas usually involves surgery. The type of surgery depends on the location and complexity of the fistula. For intersphincteric and low trans-sphincteric anal fistulas, the most common procedure is a fistulotomy or laying open of the fistula tract.
20% of fistula patients with a synthetic sling had an erosion
44.5% of all groups experienced de novo fistulas
Sub urethral fibromuscular sling decrease in urethral incontinence from 55% without the pubococcygeus
Vaginal stenosis is a problem after fistula repair – 50% of women get this after large fistula (greater than 4cm)
If left undiagnosed or untreated fistulas cause infections. That becomes chronic, causing frequent anal abscesses. This manifests as rectal bleeding and pain during bowel movements. An anal fistula is often mistaken for hemorrhoid, leading to inappropriate treatments.
Treatment using the Singapore skin flap is used. This can be from the left or right perineal areas. However, the hair can grow in the vagina when used and patients need to be warned.
There will be catheter use for 7 days for a simple fistula.
Martius flaps are not a good choice due to pain and infection.
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