What is high anal fistula

Anal fistula is a disease caused by infection, which often occurs around the anus. It has a great impact on the patient's physical health and needs timely treatment. Generally, high-position anal fistula is the most difficult to treat. Once it occurs, it is easy to cause repeated infections around the anus. Severe cases may affect sexual function. However, many people do not know much about high-position anal fistula. The following is a detailed introduction.

What is a high anal fistula?

High anal fistula refers to the fistula and its branches above the levator ani muscle and the anorectal ring, which is called anal leakage in traditional Chinese medicine. This disease can occur in people of all ages and genders, but is more common in young and middle-aged men. Anal fistula is a common anorectal disease with an incidence rate of 1.67% to 2.6%. Among them, high-position anal fistula is the most difficult to treat and is one of the most difficult diseases to treat in anorectal surgery, with a recurrence rate of about 10%.

Due to the special anatomical and physiological environment of the perianal area, once a high anal fistula occurs, it often leads to repeated perianal infection, swelling, pain and scar formation. When pus breaks through the tube wall and spreads along the sphincter gap, it can lead to serious complications such as multiple complex anal fistulas, rectovaginal fistulas, rectourethral fistulas and rectovesical fistulas, which will eventually affect the normal physiological functions of surrounding organs and even seriously threaten the patient's life safety due to sepsis infection.

What are the surgical methods for high anal fistula?

To treat high anal fistula, there are currently several methods at home and abroad, including real hanging wires, virtual hanging wires, filling the fistula tract with biological materials, and fistula removal. However, the most commonly used method for treating high anal fistula in clinical practice is still the real hanging wire method.

Because hanging a virtual thread only relieves pain but does not cure anal fistula, it is rarely performed in China. The method of filling the fistula with biological materials is currently being tried by doctors abroad, but the cure rate is low and the recurrence rate is high. Fistula removal surgery is only suitable for patients with very clear and definite fistulas. The conditions of most patients with high-position anal fistulas are relatively complicated, and very few of them are suitable for fistula removal.

Treatment of high anal fistula

1. Medication

High anal fistula cannot heal itself. Surgical treatment is the most effective way to cure high anal fistula. However, when symptoms such as pus discharge, redness, swelling, and pain occur during the attack period, drug treatment can be used to temporarily relieve the symptoms.

(1) For external treatment, take a sitz bath with a blood-activating, swelling-reducing and pain-relieving lotion and apply golden ointment externally.

(2) Use of antibiotics Antibiotics can be used during acute attacks, but the duration of use should generally not exceed one week.

(3) For internal use, take the Chinese medicine Bixie Shenshi Decoction plus Huadu Chushi Decoction with modifications. If accompanied by fever, use Xianfang Huoming Drink.

2. Surgery

Once anal fistula is formed, surgery is the fundamental method to cure high anal fistula. However, excessive damage to the anal ring during surgery can lead to irreversible anal injury and cause a series of psychological and economic burdens on patients. Therefore, the surgery must fully protect the core structure of the anus, the "anal ring." Currently, the commonly used surgical methods are mainly divided into two categories: sphincter-preserving surgery and sphincter-removing surgery.

(1) Sphincter-preserving procedures include: coring-out, floating line hanging, anal fistula resection and mucosal flap plasty, biological patch internal opening repair, biological protein glue closure and microsurgical anal fistula resection.

(2) Sphincterotomy At present, thread hanging therapy is still an important means of treating high anal fistula. It can maintain anal function as much as possible while treating high or complex anal fistula. It includes: low-cut and high-hanging method, partial suturing of cutting and hanging, incision and hanging thread placement and bidirectional isobaric drainage.