Treatment of fistula

Fistula

Fistula is an abnormal link in the form of a channel consisting of two or two blood vessels or between a cavity of the body and the skin. The fistula sometimes starts in abscess, a pocket full of pus inside the body, Such as urine and faeces, which in turn prevent the process of healing abscess, and eventually the abscess clears its way to the skin or organ or cavity body form what is known as fistula. Symptoms may include: pain, heat, itching, nausea, vomiting, diarrhea, general weakness, pus discharge, foul odor, leakage of urine or stool, or gases into the vagina.

It should be noted that fistula may be in some since birth, and may result from other causes such as; complications of surgery, infections and birth, and obstructive labor (Obstructed Labor). It can be caused by conditions such as Crohn’s Disease, Ulcerative Colitis, and people undergoing radiation therapy are at risk of multiple types of fistula. There is the so-called artificial fistula, such as the fistula designed between artery and vein to produce the so-called Arteriovenous Fistula (who is required renal dialysis) (Renal Dialysis).

Types of fistula

The fistula is classified into the following types according to the number of openings and its binding to internal organs or exiting the skin:

Closed fistula: (Blind fistula), which is open only by one side and closed by the other, and can be transformed into a complete fistula if it is not treated.
Total fistula: (Complete fistula) has an internal slot and an outside slot.
Fissile fistula: Incomplete fistula channels in the skin are open from the outside, but closed from the inside, and do not connect with any internal structure.
Fistula fistula: Horseshoe fistula is a complex U-shaped type in English that connects two outer openings on either side of the anus.

Fistula can appear in any part of the body, but it is more prevalent in the digestive system, and can be made up of two blood cells, and in the urinary system, reproductive system, and lymphatic system (in English: lymphatic systems), and examples of fistulas that can occur in Different parts of the body:

Rectal anal fistula: (Anorectal Fistula), which connects the anal canal and the skin surrounding the anus. It is worth mentioning that anal fistula affects men more than women.
Gastrointestinal fistula: (Enteroenteral Fistula) and connects two parts of the intestine.
Intestinal fistula fistula: (Enterocutaneous) and connects the small intestine and skin.
Cutaneous coliform fistula: (Colocutaneous), which connects the colon and the skin.
Endotracheal fistula fistula: Tracheoesophageal fistulas, trachea and esophagus, often due to congenital defects since birth, allowing air to enter the digestive system and food entering the lungs.
Vaginal fistula fistula: Vesicovaginal fistula (Vesicovaginal fistula) connects the vagina and bladder, causing leakage of urine from the vagina, as well as repeated infections in the bladder and vagina.
Vaginal fistula fistula: (Enterovaginal fistula), which connects the vagina and the large intestine, leading to stool leakage from the vagina.
Urethral urethral fistula: (Urethrovaginal fistula) and connects the urethra and vagina.
Venous arterial fistula: (Arteriovenous fistulas) is formed between the artery containing oxygenated blood to all parts of the body and the blood-borne vein that returns to the lung, leading to abnormal blood pressure and flow.

The specialist doctor decides the most appropriate treatment plan for fistula based on its location, size and condition. The treatments are divided into two main parts as follows:

Non-surgical treatment

It includes the following options:

Catheterization: (Catheterization) is used in the case of small fistula to treat the infection through the discharge of pus in the fistula, as in the fistula anal or rectal.
Drug therapy: Antibiotics are used to treat fistula infections, and infliximab can be used to reduce inflammation and help heal rectal fistula (fistula) in women with Crohn’s disease.
Gastrointestinal food: Enteral diet, a liquid food containing important nutrients taken orally or given through the feeding tube, is given instead of solid foods to reduce the amount of feces outside the anus and thus help to heal and close the fistula. This treatment can be used in the case of intestinal vaginal fistula, gastrointestinal fistula, and enterosesicular fistulas.
Vibrin Adhesive: Fibrin glue is a sticky medical substance that is injected into the fistula to close the duct tightly. The fistula is then sewn. It is easy, safe and painless, but its results are weak in the long term.
Laser Therapy: (Laser therapy) Laser is used to eliminate Congenital arteriovenous fistulas with relative ease if it is small.
Ultrasonic Directed Pressure: (Ultrasound-guided compression) is used in the case of intravenous arterial fistula located in the leg area if it is visible on the ultrasound device; it relies on ultrasound to press the fistula, and close the blood flow of the damaged blood vessels.
Sealer: (Plug) This plug is often made up of the collagen membrane and fills the fistula.

Surgical treatment

The fistula is surgically treated either by incisioning the abdominal wall, or by making a small incision and using a small camera and tools to deal with the fistula using laparoscopic surgery.

The method of surgical treatment includes the following steps:

Precise examination to determine the pathway of fistula across the tissues: Using special contrast dyes and imaging.
Discharge and discharge of pus collected in fistula: And to ensure the integrity of the tissues surrounding the fistula, and free from infection or inflammation.
Surgical removal of fistula: (Fistulotomy), which is used in 85-95% of cases, where the entire length of the fistula is made, and then emptied of the contents, and paved and kept in the new site until the healing and recovery.

The surgical procedure includes the following options to complete:

SITON Surgical Stitch: (Seton stitch) This stitch is produced by passing a thread through the fistula to make a knot that connects it to the outside, leaving a path for discharge and discharge.
Procedure of the rectum of the rectum: (Endorectal flap), used in the case of rectal fistula as an alternative to the Siton stitch, and involves the withdrawal of healthy tissue over the internal part of the fistula to prevent stool and other substances from causing re-infection of the channel.
Vibrin Adhesive: Which was previously mentioned in non-surgical treatments, or The seal made of biological materials (Bioprosthetic plug), which are conical made of human body tissue. They are used to close the inner opening of the fistula and are fastened to the stitches. It should be noted that it does not close the fistula to allow for drainage, and then grow new tissue around the plug to fit the fistula and treat it.