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Session:: Ongoing Videos

V43 - Multimodality Treatment Of Complex Fistula In Ano Extended Up To Sacrum

Saturday, May 9, 2026
On-Demand
All of the relevant financial relationships listed below have been mitigated.
Alok Mohanlal Gupta, n/a: This individual has no financial relationships with ineligible companies.
Purpose/Background: A 43 year old male patient having grade 5 complex recurrent fistula in ano was operated 4 times previously.

1.Incision and drainage in Dec 2020.

2.EAU+ Seton in Feb 2021.

3.EAU+ Seton in June 2021.

4.VAFT in Feb 2022.

K/C/O DM (TYPE 2)

K/C/O Bronchial asthma

K/C/O Multi drug resistance

AIMS AND

Objectives:

To cure the complex and recurrent fistula completely.

Methods/Interventions:

Method:

Procedure Details: Fistulotomy/Fistulectomy and LASER Ablation

Under all aseptic precautions, the patient was placed in the lithotomy position, followed by standard skin preparation and draping.

Methylene blue dye mixed with H2​O2​ was instilled through the external opening.

Internal openings were identified: one at the 7 o'clock position at the dentate line, and two separate rectal openings were also visualized at the 7 o'clock and 5 o'clock positions.

The internal opening at the 7 o'clock position was cored out from the dentate line up to the anorectal ring. The associated rectal opening was scooped out and closed with a figure-of-8 suture using Vicryl 2.0 (27 mm, 5/8 circle, round-bodied needle).

Similarly, the internal opening at the 5 o'clock position in the rectum was scooped out and closed with a figure-of-8 suture using Vicryl 2.0.

The main tract was cored out from the external opening up to the infra-levator level. The remaining proximal tract was then thoroughly scooped out and LASER ablation was performed using a radial fibre of the diode LASER.

A Foley's catheter was placed as a drain, with a urobag attached to monitor and measure any remaining pus drainage.

A small anal pack, soaked in Betadine and Metronidazole, was placed, and a sterile dressing was applied.

The procedure was uneventful. The patient was shifted to the room with stable vitals.

Results/Outcomes: RESULT:

Pus drainage from the cavity and three tracts initially measured 100 mL but became completely absent (nil) after one month.

The wound and all internal openings achieved complete healing after four months

Thus, 4 times previously operated patient is completely cure up till now using multimodality treatment and proper post operative dressing and care.

Conclusion/Discussion:

Conclusion:

Grade 5 recurrent complex fistula extended up to sacrum, was completely cured with multimodality treatment.

Multimodality Treatment Of Complex Fistula In Ano Extended Up To Sacrum
Multimodality Treatment Of Complex Fistula In Ano Extended Up To Sacrum