Q What Is Anal Fistula or Fistula-in-ano?
Anal Fistula is
an abnormal passage (communication) between the interior of the anal canal or
rectum and the skin surface around the anus.
the fistula may communicate from anus (rectum) to Vagina
(Recto-Vaginal Fistula), Urinary Bladder (Recto-Vesical
Fistula), Urethera (Recto-Uretheral Fistula) or other
pelvic structures, including the bowel.
|A probe put in
through external opening
|and coming out
through internal opening
Q What is a Fistula? How is it different from a Sinus?
is a tract (passage) which communicates between two
surfaces or body parts. Therefore it has two openings.
Whereas, a Sinus starts from a surface and ends blindly
without connecting to any other surface. Therefore, a
sinus has only one opening.
of an Anal Fistula, the two body parts which the
fistula tract connects are the anus (rectum) lining and
the skin (around the anus or buttock) . In cases of Peri-anal
Sinus, the opening in the skin doesn't connect to the anus
(rectum). However, Peri-anal Sinus cases are not common
and most of the times, such cases are Anal Fistula cases
with a very small anal opening.
Q Why is Anal
Fistula such a dreaded (feared) disease? Is it really
Fistula is a dreaded disease. This is basically for three
1. If the
treatment is not done, the pus inside the fistula can
spread further leading to formation of multiple tracts and
several opening in the skin around the anus. This makes
the fistula more complex and further difficult to treat.
Fistula treatment is associated with high recurrence rate.
A lot of patients who get themselves operated by routine
surgeons have to undergo multiple operations to get cured.
The lure of curing this disease without operation by
quacks further complicate the treatment. Therefore, Anal
Fistula should always be treated by an expert Colo-Rectal
Surgeon who is proficient in dealing with Anal Fistulas.
important issue is that many surgeons are used to
/comfortable doing a particular procedure for Fistula.
They do the same procedure in all the patients. There
are 5-6 procedures to treat Anal Fistulas and none of
these procedures is perfect. Therefore, different
procedure is indicated (should be done) in different
patients, depending upon the type and complexity of that
patient's fistula. A single procedure cannot and should
not be done in all the procedures. Very few surgeons are
expert in doing all the procedures of Anal Fistulas.
There is a risk, though low, of cancer formation in the
long standing Anal Fistulas. Therefore, Fistulas should
always be treated at the earliest.
Contribution of Dr Pankaj Garg to the World
Surgical Literature in the field of Anal Fistulas
Pankaj Garg, Jeremy Song, Amarjit
Bhatia, Hemant Kalia, Geetha Menon.
The efficacy of Anal Fistula
Plug in Fistula-in-ano: A systematic review.
Colorectal Disease 2010 Oct;12(10):965-70
Disease is the official journal of British & European
Society of Coloproctology and is the second highest
ranking Colo-Rectal journal in the world)
Pankaj Garg. Randomized clinical trial
of anal fistula plug versus endorectal advancement flap
for the treatment of high cryptoglandular fistula in ano.
British Journal of Surgery, 2009
Journal of Surgery is the official journal of
Association of Surgeons of Great Britain and Ireland,
Sweden, Spain & Netherlands and is the second highest
ranking Surgery journal in the world)
Pankaj Garg. To determine the
efficacy of anal fistula plug in the treatment of high
fistula-in-ano- an initial experience. Colorectal
(Colorectal Disease is
the official journal of British & European Society of
Coloproctology and is the second highest ranking Colo-Rectal
journal in the world)
Pankaj Garg. Flaps, Plugs & Glues- A view from the east.
Seminars in Colon and Rectum Surgery. 2009;20:52-57
(Seminars in Colon & Rectum Surgery is prestigious
Acellular extracellular matrix Anal Fistula
Plug: Results in high fistula-in-ano awaited.
World Journal of
December 14; 14(46):7143
(World Journal of
Gastroenterology is a high ranking journal published
by Dr Pankaj Garg on Anal
Fistula in leading International & National Surgery
Pankaj Garg, Vinayak Misra, Yogesh
Misra. Video-Assisted Anal Fistula Treatment As A
Minimally Invasive Treatment For Transsphincteric
Fistula-In-Ano.. Presented at Annual conference of
American Society of Colo-rectal Surgeons(ASCRS),
Phoenix, Arizona, USA, April 28-30, 2013
Pankaj Garg, Mohamed Ismail. "The
efficacy of Anal Fistula Plug in Fistula-in-ano: A
systematic review"- Selected for presentation in the BEST
paper category- Asian Federation of Colo-proctology (AFCP)
conference at Goa, India, September, 2009.
Pankaj Garg. “Treatment of Fistula-in-Ano
by Anal Fistula Plug: A prospective study from Asia.”
Presented in the BEST Paper Category at International
Society of University Colon & Rectal Surgeons(ISUCRS)
Biennial conference, San Diego, USA, September 16, 2008.
Pankaj Garg, Mahesh Rajagopal, Vino
Verghese, Mohamed Ismail. “To determine the efficacy of
anal fistula plug in the treatment of high fistula-in-ano-
an initial experience”. Presented in Best Research Paper
Category at Association of Colon & Rectal Surgeons of
India (ACRSI) annual conference, Mumbai, September 20th
Pankaj Garg.(December, 2007) “Anal
Fistula Plug- a new procedure- An Indian experience”-
Selected in the BEST paper category and was awarded FIRST
PRIZE- Annual conference of Association of Surgeons of
India(ASI), Bhubneswar, India, December, 2007
“Anal Fistula Plug- An Indian experience.” Presented at:
Indian Association of Gastro-Intestinal Endoscopic
surgeons; Srinagar,Kashmir, India, June 2007.
Pankaj Garg. “A new procedure- Anal Fistula Plug.” An oral
presentation at: Association of Surgeons of India(Delhi
state chapter); New Delhi, India, October 2006.
Articles by Dr Pankaj Garg in leading Newspapers on Anal
The Tribune (National Edition)- July 7,
fistula — simple solutions for a complex disease
The Indian Express-
New method of treating anal
The Times Of
New technique to treat anal
Amar Ujala- Apr 18, 2007-
Anal Fistula treatment made easier by Anal
The Tribune (National Edition) - 24
Jan, 2007- Anal fistula patients
can smile now
Punjab Kesri (National Edition) - May
12, 2007- Treatment by Anal
The Tribune (National edition)- Mar 19,
2008- Piles, Fissure, Fistula-No
Rojana Spokesman- Oct 12, 2006- Now
anal fistula can be treated by a new method