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Anal Fistula...

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.

Rarely, 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?

Fistula 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.

In case 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 dangerous?

Anal Fistula is a dreaded disease. This is basically for three reasons

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.

2. Anal 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.

3. Another 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.

4. 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

(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. 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 Jul 9;96(8):958-959.

(British 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 disease 2009;11:588-591.

(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 American journal)

Pankaj Garg. Acellular extracellular matrix Anal Fistula Plug: Results in high fistula-in-ano awaited. World Journal of Gastroenterology 2008, December 14; 14(46):7143

(World Journal of Gastroenterology is a high ranking journal published from China)

Presentation by Dr Pankaj Garg on Anal Fistula in leading International & National Surgery Conferences

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 2008.

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

Pankaj Garg. “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 Fistula

The Tribune (National Edition)- July 7, 2010-.Anal fistula — simple solutions for a complex disease


The Indian Express- Oct 12,2006- New method of treating anal fistula introduced

The Times Of India- Oct 12,2006- New technique to treat anal Fistulas


Amar Ujala- Apr 18, 2007- Anal Fistula treatment made easier by Anal Fistula Plug

The Tribune (National Edition) - 24 Jan, 2007- Anal fistula patients can smile now



Punjab Kesri (National Edition) - May 12, 2007- Treatment by Anal Fistula Plug

The Tribune (National edition)- Mar 19, 2008- Piles, Fissure, Fistula-No longer incurable


Rojana Spokesman- Oct 12, 2006- Now anal fistula can be treated by a new method







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