Anal fistulaK60.30

• A distinction is made between:
  • Incomplete external or internal fistula: Only one fistula opening present.
  • Complete fistula: Continuous fistula passage, fistula opening in the skin and rectal mucosa.
• Classification by parks:
  • Subcutaneous Fistula
  • Submucous fistula
  • Intersphincteric fistula
  • Transpinct Fistula
  • Suprasphinous fistula
  • Extrasphincteric fistula
  • Recto-organic fistula.

• Treatment scheme see also Table 1: Inpatient procedure under general or spinal anaesthesia, exception: subcutaneous fistulas.
• Complete surgical splitting of all accessible fistula ducts under antibiotic protection with a broad spectrum of action, e.g. doxycycline (e.g. Doxy-Wolff) 200 mg/day p.o. or i.v. Alternatively, in case of suspected anaerobic infection: Clindamycin (e.g. Sobelin Kps. 150 mg) 3 times/day 2 Kps. or Metronidazol (e.g. Clont 400) 2-3 times/day 1 tbl. p.o.
• Procedure: probing of the fistula duct by means of a button probe, visualisation with methylene blue, cleavage by means of a channel probe, fistulaography, removal of the granulation tissue lining the fistula by curettage or excision in triangular form with removal of the involved glands (proctodermal glands).

Notice! Exclusion of M. Crohn (colon contrast enema), because in this case no fistula splitting but scraping is performed!

• Aftercare with sitz baths with antiseptic additives ( antiseptics), e.g. quinolinol solution(e.g. Chinosol 1:1000), quinolinol sulphate monohydrate solution 0.1%, iodine-containing topicals (e.g. Betaisodona perineal antiseptic) or antiphlogistically with chamomile flower extract (e.g. Kamillosan). In open wound treatment, irrigation of the fistulas with antiseptics such as polihexanide (Serasept, Prontoderm) or polyvidone-iodine (Betaisodona), in case of a clean wound bed, granulation-promoting measures, e.g. varidase gel. Stage-specific wound treatment.

Treatment scheme for anal fistulas