Anal fistula (plural fistulae), or fistula-in-ano, is a chronic abnormal communication between the epithelialised surface of the anal canal and (usually) the perianal skin. An anal fistula can be described as a narrow tunnel with its internal opening in the anal canal and its external opening in the skin near the anus. Anal fistulae commonly occur in people with a history of anal abscesses. They can form when anal abscesses do not heal properly.
Anal fistulae originate from the anal glands, which are located between the internal and external anal sphincter and drain into the anal canal. If the outlet of these glands becomes blocked, an abscess can form which can eventually extend to the skin surface. The tract formed by this process is a fistula.
Abscesses can recur if the fistula seals over, allowing the accumulation of pus. It can then extend to the surface again - repeating the process.
Anal fistulae per se do not generally harm, but can be very painful, and can be irritating because of the drainage of pus (it is also possible for formed stools to be passed through the fistula). Additionally, recurrent abscesses may lead to significant short term morbidity from pain and, importantly, create a starting point for systemic infection.
Treatment, in the form of surgery, is considered essential to allow drainage and prevent infection. Repair of the fistula itself is considered an elective procedure which many patients opt for due to the discomfort and inconvenience associated with an actively draining fistula.
thus fistula in ano denotes communicating track from anal canal or rectum to perineal skin, while the Pilonidal Sinus(PNS)is a subcutaneous infection occurring in the upper half of gluteal cleft commonly having no communication with anal canal.
Treatment…
K S L T … the kshar sutra is placed into the fistula/ sinus tract from one opening (commonly outer or most visible site) and passed out from another (internal or foremost site )opening and than both ends of kshar sutra are knotted together which Facilitates the permanent drainage of pus from the track and the kshar starts its work &the debridement of slough with cutting and healing of infectious track becomes faster ,it takes about one week for 1 cm of track to cut and heal leading to loosen of KsharSutra, on the next sitting the kshar sutra might be changed by rail technique & tightened again as per the patient's pain bearing capacity.
This gradual cutting & healing of fistula /sinus tract leads to healthy regeneration of cell that's why the common side effect of anal incontinence of contemporary surgery does not occur & the success rate of kslt is highest among other treatments of anal fistula which is about 98%-99% while the success rate of so called modern surgical treatments is about 50%-60%only.
In general there is no need of any bed rest & patient can continue his/her daily routine works as per his/her physical strength.
MCDPA therapy is used with kslt & up to next 30days.