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Apr07
ALL About to know Fistula
Dr. Samrat Jankar is one of the most expert reliable and ethical fistula specialists in Pune. He is a qualified surgical gastroenterologist and colorectal surgeon and had been awarded a gold medal for fellowship in colorectal surgery by the ACRISI (Association of Colon & Rectal Surgeons of India) board. Furthermore, he has been an international faculty member in this field. Recently, he has been awarded the First Prize for the best video presentation at FISTULACON 2021 for the LASER LIFT procedure in complex fistula in Ano in an international summit organized by ACRSI. He delivered talks on fistula at many national and international conferences and had a live demonstration of fistula surgery at many conferences. He had trained many surgeons for LASER fistula surgery. Dr. Samrat Janakr had been trained for complex fistula in ano surgery under renowned fistula surgeons Dr. Parvez Sheikh (Mumbai) and Dr. Arun Rajunasakul (Bangkok). He is an expert in many surgical procedures for fistula treatment and also pioneered his own surgical technique PILTEC for complex fistula treatment which has the highest success rate. Dr. Samrat Jankar had successfully Performed more than 5000+ successful Anal Fistula Surgeries.

Fistula (Bhagandar) Treatment in Pune
An anal fistula is a tunnel connecting the skin near the anus to the inside of the bowel (usually the rectum). This means that the inside of the bowel is connected to the outside of the body through an additional opening. An anal fistula often results from a previous or current anal abscess. As many as 50% of people with an abscess get a fistula. However, a fistula can also occur without an abscess.


Fistula in Ano treatment options
Surgery is usually necessary to treat an anal fistula as they usually do not heal by themselves or only with medication. The goal of any surgery for a fistula in ano is to balance between getting rid of the fistula and protecting the anal sphincter muscles, which could cause incontinence if damaged. In fistula treatment in Pune what matters most is recurrence and incontinence, the only expert in fistula surgery will have a clear understanding of it. Looking for the best doctor for fistula in ano treatment in Pune, Dr. Samrat Jankar an Internationally recognized surgeon at KAIZEN Gastro care, Wakad Pune offers holistic treatment for complex fistula with the least recurrence rate & almost zero incontinence rate.


Types of Fistual in Ano
Fistulas are classified by their relationship to parts of the anal sphincter complex (the muscles that allow us to control our stool). They are classified as

Intersphincteric
Transsphincteric
Suprasphincteric
Extrasphincteric.
Intersphincteric is the most common and Extrasphincteric is the least common. These classifications are important in helping the surgeon make treatment decisions

What is Complex Fistula?
The Standards Committee for the American Society of Colon and Rectal Surgeons (ASCRS) divided anal fistula into simple and complex types based on the complexity of fistula, risk of recurrence, and risk of incontinence.

Simple fistula:

Simple fistulas are those that are Intersphincteric or low Transsphincteric involving less than 30% of the external sphincter where the risk of incontinence is low.

Complex fistula:

“Complex” fistulas included those with

More than 30% sphincter muscle involvement
Anterior fistulas in female patients
Recurrent fistulas
Fistula associated with preexisting fecal incontinence, inflammatory bowel disease, or prior radiation.
There are several different procedures. The best option for you will depend on the position of your fistula and whether it’s a single channel or branches off in different directions. Surgery aims to heal the fistula while avoiding damage to the sphincter muscles, the ring of muscles that open and close the anus, which could potentially result in loss of bowel control.

The main options are outlined here:
1. Fistulotomy:
The most common type of surgery for anal fistulas is a fistulotomy. This involves cutting along the whole length of the fistula to open it up so it heals as a flat scar. A fistulotomy is the most effective treatment for many anal fistulas, although it’s usually done in simple fistula where the risk of incontinence is less. This procedure is not suitable in complex fistula in ano in cases where the risk of incontinence is considered too high, sphincter preserving procedures are recommended.

At KAIZEN Gastro Care, Dr. Samrat Jankar Fistula Specialist Surgeon in Pune uses a LASER as an adjunct to Fistulectomy to minimize the risk of damage to the sphincter muscle. Thus, with the added advantage of Laser, the chances of post-operative pain will be negligible.


2. Ligation of the intersphincteric Fistula Tract (LIFT):
The ligation of the intersphincteric fistula tract (LIFT) procedure is a best treatment for fistulas that pass through the anal sphincter muscles, where a fistulotomy would be too risky. This is a Highly efficient procedure with almost no recurrences or incontinence. Dr. Samrat Jankar, a well-known colorectal surgeon in Pune, specializes in complex fistula surgery


Moreover, he is adept in LIFT, an advanced procedure for fistula treatment in Pune. Being well-trained with the LIFT procedure under Dr. Arun Rajunasakul (pioneer of the LIFT procedure, to date, Dr. Jankar has performed more than 1000 modified LASER LIFT procedures with excellent results. Had been awarded the best video award at an international conference for the management of complex fistula.

3. FiLaC ( Fistula-tract Laser Closure):
It is a minimally invasive fistula-in-ano surgery that keeps the sphincter intact. This technique attempts to gently remove the anal fistula by using laser energy. The flexible, all-around radiating fiber-optic probe is inserted into the fistula tract from the outside. Then the laser is slowly withdrawn. The inflammatory tissue is destroyed in a controlled manner and the fistula tract contracts. The anal gland that originally caused the fistula is inactivated


4. VAAFT:

Video-assisted anal fistula treatment (VAAFT) is a new minimally invasive and sphincter-saving endoscopic treatment for complex fistulas. The fistula tract and internal fistula are localized using a fistuloscope inserted through the external opening and under direct vision fistula tract is destroyed from the inside and closure of the internal opening is done by stapling or suturing or cutaneous-mucosal flap.

Advantages

No surgical wounds on the buttocks or perianal region.
The internal opening is precisely located which is important in the treatment of any fistula.
Less chance of damage to the sphincter muscle
Potential drawbacks

The biggest argument against VAAFT is its high rate of recurrence (~30%)
Higher cost of treatment
5. FISTULA PLUG
The fistula plug is a 100% synthetic bio-absorbable scaffold. This plug is placed in the fistula tract. Over time cells from the body migrate into the scaffold and new tissue is generated as the body gradually absorbs the plug material, leaving no permanent material in the body.

Advantages of Fistula Plug

No cutting involved and no operation wound. Therefore it is associated with less pain and faster recovery.
No damage to the sphincter muscle.

Potential Drawbacks

Failures can occur due to the dislodgement of the plug from the fistula tract.
The plug can get infected
Failure of treatment can occur in 25-30% of cases
6. PILTEC: a modification of the LIFT procedure
Dr. Samrat Jankar an internationally recognized fistula surgeon pioneered the LASER procedure named PILTEC having the highest cure with zero incontinence rate. He had demonstrated at many surgical conferences and workshops. He had trained many surgeons in fistula treatment using the PILTEC procedure.

Why does the Fistula recur again and again?
Anal fistula treatment remains a challenge for surgeons owing to its persistence or recurrence. Recurrent anal fistulas after surgery are more difficult to treat as there is even more risk of re-recurrence. Now, the challenge is that, even with the availability of so many techniques, there is a high risk of recurrence of the fistula after surgical intervention depending upon the location of the fistula, the kind of procedure performed, the expertise of the surgeon, extent of disturbing anatomy of the perianal region, unexpected findings, the effect of excess fibrosis and scarring after surgery and lack of proper postoperative care in the early and late periods following the surgery. This means that fistulas can keep on coming back even after surgery.

According to Dr. Samrat Jankar, a successful fistula surgery requires proper diagnosis, a perfectly performed and reported MRI, along with the surgeon’s expertise and the method of surgery. Dr. Samrat Jankar, the best fistula surgeon in Pune pioneer of the PILTEC procedure. In almost all cases Dr. Samrat Jankar performs a single-setting surgery with a success rate of more than 98% including fistula with perianal abscess. It is not only about surgery at kaizen gastro care dr Samrat Jankar and their team provide very good postoperative care which is one of the most important components in the complete cure of fistula.

What symptoms does anal fistula surgery address?
The signs and symptoms of an anal fistula include:

Frequent anal abscesses
Pain and swelling around the anus
Bloody or foul-smelling drainage (pus) from an opening around the anus. The pain may decrease after the fistula drains.
Irritation of the skin around the anus from drainage
Pain with bowel movements
Bleeding
Fever, chills, and a general feeling of fatigue
Anal fistula surgery aims to correct an anal fistula and treat all of its associated symptoms. If you have any of the above symptoms or you’re concerned about having an anal infection, abscess or fistula, speak with Kaizen fistula specialist Dr. Samrat Jankar, the best fistula doctor in Pune.

How is an anal fistula diagnosed at Kaizen Gastro Care:
Dr. Samrat Jankar at KAIZEN Gastro Care usually diagnoses an anal fistula by examining the area around the anus. He will look for an opening (the fistula tract) on the skin, then try to determine how deep the tract is, and the direction in which it is going. In many cases, there will be drainage from the external opening. Some fistulas may not be visible on the skin’s surface. Most of the time need further tests to better understand fistula relations with sphincter. An anoscopy is a procedure in which a special instrument is used to see inside your anus and rectum. Also in most cases, he advises an MRI fistulogram of the anal area to get a better view of the fistula tract. Some atypical cases need a colonoscopy to rule out IBD which will be the cause of the recurrence of fistula.

What causes an anal fistula?
The leading causes of an anal fistula are clogged anal glands and anal abscesses. Other, much less common, conditions that can cause an anal fistula to include:

Crohn’s disease (an inflammatory disease of the intestine)
Radiation (treatment for cancer)
Trauma
Sexually transmitted diseases
Tuberculosis
Diverticulitis
Colorectal Cancer
Post-operative care after fistula surgery
Take sitz baths (sit for 15-20 minutes in warm water with antiseptic solution) three times a day and after each bowel movement for the first few days.
If you were given a topical ointment, place this over the anal skin and a little into the anal canal 2-3 times a day.
Don’t worry if you have some bleeding, discharge, or itching during your recovery. This is normal.
Avoid constipation.
Take stool softener before bedtime every day till wound healing.
The use of dry toilet tissue should be avoided. After bowel movements use a jet water cleaning, if possible, followed by taking a warm bath.
If you were given a prescription for an ointment, apply these two or three times a day at the edge of the anal opening and inside by finger (not by applicator).
Eat a regular diet including plenty of fresh fruit and vegetables. Drink 6-8 glasses of water a day.
Connect with your surgeon if your temperature is greater than 101 degrees, significant bleeding, and unbearable pain.

Why Choose Kaizen Gastro Care for Fistula Treatment:
Experienced Fistula Specialist Team: Dr. Samrat Jankar is renowned as the best Fistula Specialist in Pune which is available at Kaizen Gastro Care Pune for treating various Piles, Fistula, and other anal diseases.
Advanced diagnosis and treatment: Kaizen Gastro Care provides a full range of diagnostic tests and innovative treatments which are used for the diagnosis and management of different Piles and Ananl conditions.
Clinic Location: Kaizen Gastro Care Clinic is located at the Pune and PCMC Prime location i.e. Wakad Area. This is the central location of Pune city. The patient can easily come with all public transport.
Leading-edge technology: Kaizen Gastro Care is equipped with leading-edge technology such as Endoscopy tests, Manometry, 24 Hr Ph Monitoring, Biopsy, and biofeedback. Also equipped with Piles Specialists and nutritionists.
A Dedicated Center for Fistula Treatment: Kaizen Gastro Care is the First Dedicated center for Fistula and different Anal Disease treatments in Pune and all over Maharashtra.
We Manage Your Care for the Long Term: We at Kaizen Gastro Care manage Piles, Fistula, and Anal disease for the long term. Kaizen Gastro Care manages the patients for the long term, taking regular follow-ups and long-term care.


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