Anal fistula and Pilonidal Sinus surgery

An anal fistula is a small tunnel that forms between the end of the bowel and the skin near the anus, where faeces exit the body. Typically, anal fistulas develop because of an infection near the anus that leads to the accumulation of pus (abscess) in the surrounding tissue. As the pus drains away, it can leave a small channel or tunnel behind. Anal fistulas can cause discomfort, skin irritation, unpleasant discharge, and usually do not heal spontaneously.

Surgery is often the recommended treatment for anal fistulas due to these symptoms.

Video-Assisted Anal Fistula Treatment (VAAFT) involves using a miniature camera to examine the fistula tract. During the procedure, the surgeon uses a cautery to burn the internal lining of the tract and a brush to clean it. The internal opening of the fistula, leading to the anus or rectum, may be either closed during the procedure or left for closure at a later time.

The primary objectives of VAAFT are to:

• Locate the opening of the fistula.
• Flush the fistula tract.
• Identify the trajectory of the fistula.
• Reduce the necessity for MRI scans over time.
• Close the fistula tract internally by cleansing and cauterizing the fistula canal, removing waste material, and closing the internal opening of the fistula.

The reported success rate of VAAFT surgery ranges from 70% to 80%.

Compared to other treatments, VAAFT offers several benefits:

• It is performed under direct vision.
• It helps to identify any possible secondary tracts or chronic abscesses.
• It preserves anal continence.
• Wounds are quite small and do not need packing.
• Postoperative pain is minimal.

Patients may experience minor adverse effects following a VAAFT procedure, including:

• Minor Bleeding and Pain: Most individuals may encounter some degree of bleeding from the wound or anus post-operation. This bleeding is typically benign and does not raise significant concerns.
• Pus Discharge: Some patients may develop pus discharge from the external opening of the fistula. If accompanied by a high temperature, it may indicate a wound infection, requiring antibiotics.
• Fluid-Induced Swelling: Fluid used to wash the fistula tract during VAAFT may occasionally cause swelling. This swelling usually resolves over the course of 3-4 days without intervention.

Patients are encouraged to start moving around as soon as possible after the procedure to improve recovery and reduce the risk of complications. Within one to two hours of the operation, patients will be encouraged to get up and walk around. Discharge from the hospital will be on the same day (for planned day-case surgery) or the following day.

A pilonidal sinus is a small tunnel in the skin at the top of the buttocks, where they divide (the cleft). It does not always cause symptoms and only needs to be treated if it becomes infected. Most people with a pilonidal sinus do not notice it unless it becomes infected and causes symptoms. An infection will cause pain and swelling, and a pus-filled cavity (abscess) can develop.

Endoscopic Pilonidal Sinus Treatment (EPSiT) is a new, less invasive treatment performed at Brighton Nuffield Hospital. It involves using a tiny camera to explore the sinus. The internal lining of the sinus is safely burnt (cauterised) and cleaned with a brush. Some people may need more than one EPSiT session for complete healing of the sinus. This procedure is often performed as a day-case procedure under a brief general anaesthetic, spinal anaesthetic (awake anaesthesia with a needle injection into the back for patients with significant heart or lung diseases), or under local anaesthesia in selected patients.

Compared to traditional surgical removal of the sinus, EPSiT offers several benefits:

• The surgeon can see the sinus (tunnel) using a tiny camera, helping to identify complex sinuses with branching tunnels and abscesses.
• The natal cleft is not affected.
• Wounds are quite small and don’t need insertion of packing material.
• Patients experience less pain after the procedure and can return to work and daily life much faster.

• Pain and Minor Bleeding: Common side effects of EPSiT.
• Discharge from the Sinus: If accompanied by a high temperature, antibiotics might be needed to treat a wound infection.
• Fluid-Induced Swelling: Fluid used to wash the sinus tract during EPSiT may cause swelling around the natal cleft in rare cases (1 in 20 patients). This swelling usually resolves by itself after a few days.
• Minor Bleeding from the Wound: Most people experience a small amount of bleeding from the wound, which may be more noticeable after dressing changes. This is normal and not a cause for concern. Wearing a small pad inside your pants can protect your clothes from staining.