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Colorectal

What is an Anal Fistula?

The definition of colorectal or anal fistula is an abnormal tunnel or a communication between the inside of the anal canal where there is usually an internal opening and the skin outside the anus or perianal skin and skin of the buttocks.  This tunnel is known as the fistula tract or the primary fistula tract, which can go through varying proportions of the anal sphincter, the muscle that surrounds the anus and keeps us continent and stops us from leaking and soiling fecal matter.

Hemorrhoids treatment and prevention concept, 3D illustration

Causes and Aetiology

A majority of anal fistula are so called idiopathic or cryptoglandular, where an infection within the anal gland is thought to be the origin of the infection inside the anal canal between the two muscles and from this, the tract or the tunnel forms and points to various directions either to the buttocks or comes between the muscles and different types of fistula are formed.  A smaller proportion of anal fistula are caused by inflammatory bowel condition such as Crohn’s disease or ulcerative colitis and there are other rare causes such as tuberculosis and other rare infections, sometimes radiotherapy treatment for example to treat the prostate or other pelvic organs such as the cervix can cause fistula and rarely anal or rectal cancer can produce the fistula.

Can the Regenerative Clinic help?

Our renowned medical team provides a range of treatments, from the traditional to the innovative:

Lipogems®

Adipose Tissue therapy and treatment: a pioneering new treatment for pain and inflammation is a new minimally invasive treatment that harnesses natural repair cells removed from your own body fat to target various inflictions.

Lipogems® treatment for fistula has the advantage of not involving any significant trauma and having minimal side effects compared to the fistula preserving surgical procedures and at least being as successful, if not more, than those more complex procedures. 

Read more clinical evidence supporting all our treatments here.

What are the symptoms of anal fistula?

Anal fistulae usually cause discharge or infections around the anus called abscesses.  Abscesses are extremely painful swellings, which contain pus and a collection of liquid pus which can spread around the anus and either produce an infection that points to one area and bursts and discharges spontaneously or has to be drained as an emergency operation.  If an infection is not drained, it can spread upwards and into the pelvis and can cause severe sepsis or systemic infection. 

Why have a consultation at the Regenerative Clinic?

Our experienced consultants will undertake a thorough examination exploring non-surgical and surgical treatments. They’ll also discuss your suitability for our state-of-the-art biological therapies. 

What makes me unsuitable for fistula treatment?

Lipogems® are not suitable for treatment of patients who have active infection and abscess or so called secondary extensions where there is more than one tract; there is usually the primary main tract that goes through the muscle but also other separate branches, a network of tunnels, which can cause infection.  Unless these tunnels are first dealt with and divided and laid open at a separate operation and a Seton is inserted through the primary tract for a period of two to three months, Lipogems will not be suitable. 

There is also currently no knowledge or no data on the use of Lipogems® for treatment of fistula in the presence of cancer or tuberculosis and other infections but the Lipogems® can be used in treatment of fistula associated with Crohn’s disease.

Can I have this treatment if I've had cancer?

This depends on the cancer and whether or not it is in remission.  Treatment can not be given if the cancer is involving the anus or the rectum but if it is cancer of other parts of the body, which is fully treated, then Lipogems® can be used for treatment of fistula which is unrelated to it.

Post op recovery

The procedure is carried out as a day case procedure. You are free to leave the hospital within four to six hours of their procedure and will be sent home with a course of oral antibiotics and some painkillers alongside instructions how to manage yourself postoperatively. You are free to walk and carry out small daily activities, but should avoid strenuous exercise for 5-7 and should not return to work for approximately the same period of time.

Mr Emin Carapeti

Colorectal Surgery, General Surgery
Bsc MBBS MD FRCS(Gen)
emin-carapeti-closeup

Emin Carapeti is Consultant General and Colorectal Surgeon and worked as a consultant at Guy’s and St. Thomas’ Hospital Trust. He is a Member of Council of the Section of Coloproctology of the Royal Society of Medicine, a member of the Association of Coloproctology of Great Britain and Ireland and an examiner in surgery at the Royal College of Surgeons of England. He graduated from Guy’s Hospital and undertook his training in London and South East England. His specialist training was at St. Mark’s Hospital in London and Mount Sinai Hospital in Toronto.

Clinical Evidence

Preliminary Study on the Echo-Assisted Intersphincteric Autologous Microfragmented Adipose Tissue Injection to Control Fecal Incontinence in Children Operated for Anorectal Malformations

To assess the efficacy of a novel technique (echo-assisted intersphincteric autologous microfragmented adipose tissue injection, also called “anal-lipofilling”) in the management of non-responsive fecal incontinence in children born with anorectal malformations (ARMs). Click here to read the study.

Autologous adipose-derived stem cells for the treatment of complex cryptoglandular perianal fistula: a prospective case-control study

Complex cryptoglandular perianal fistula (CPAF) is a kind of anal fistula that may cause anal incontinence after surgery. Minimally invasive surgery of anal fistula is constantly emerging. Over the past 20 years, there are several sphincter-sparing surgeries, one of which is autologous adipose-derived stem cell (ADSC) transplantation. However, to date, there is no study regarding the treatment of complex CPAF with ADSC in China. This is the first study in China on the treatment of complex CPAF with ADSC to evaluate its safety and efficacy. Click here to read the study.

Refractory Complex Crohn’s Perianal Fistulas: A Role for Autologous Microfragmented Adipose Tissue Injection

Complex perianal fistulas represent one of the most challenging manifestations of Crohn’s disease. Combined surgical and medical therapy with biologic drugs today represent the first-line treatment option, but its efficacy does not exceed 60%. Recently, new therapeutic approaches, such as the use of mesenchymal stromal cells, have shown promising results. The adipose tissue is an abundant and easy to access source. The effectiveness, safety, and feasibility of local injections of microfragmented adipose tissue in patients with refractory complex fistulizing perianal Crohn’s disease (PCD) were evaluated. Click here to read the study.

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