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Fistula in ano denotes a small opening/openings by the side of the anus discharging blood mixed foul smelling pus staining the undergarments of the patient. Fistulae either result from a ruptured abscess or a surgically drained peri-anal abscess.
These fistulae become painful if the outer opening gets blocked. All these fistulae will have a communication with the rectum and hence do not spontaneously close. Some fistulae are superficial called low anal fistulae and some are quite deep called high anal fistulae. Some fistulae are multiple or branched. There is no medical treatment for fistula-in-ano. All the fistulae require surgical treatment and these are notorious for recurrence. A MR fistulogram will be necessary in complex fistulae before planning out surgery. Simple low anal fistulae can be cured by a simple surgery. Complex fistulae may require staged operations or multiple operations for a complete cure. Some of them require a seton suture. A new equipment called VAAFT (video-assisted) seems to be of promise in complex fistulae. Fistula surgery including VAAFT can be done on a day-surgery basis.