u/AdGrouchy7150

Hello, has anyone gotten this procedure done?

How was the post op recovery period?

Did you face any incontinence issues?

Was there any fistula recurrence post this?

Planning to get a fistulectomy done by Dr Parvez Sheikh & Dr Atef Bazka in Mumbai, India. Apparently they are pioneers of this technique.

Most other CRS have advised a 2 stage process - seton + abscess drainage + partial fistulectomy, followed by a definitive surgery later on.

But the doctors above are confident of getting the abscess drained and fistulectomy done all in 1 stage.

Fistula is complex (MRI readings as below)

- Perianal fistula with internal opening at 5-6 o' clock position associated with small intersphincteric collection.

- Trans sphincteric tract at 6-7o' clock position tracking superiorly with associated abscess in the ischioanal region on the right side and tracking along the right levator ani muscle with supralevator extension(air seen within). Linear tract seen from this collection to the right gluteal cleft region :previously placed drain tube.

- Ramification at 5-6 o' clock position with a transsphincteric course and tract from 1-5 o' clock position, no focal collection on left side.Tract seen from the previously placed drain tube in the left gluteal region communicating with this tract at 3-4 o' clock position.

Hi all,

My husband has a complex trans-sphincteric fistula with origin at 6 pm, which has a right supralevator extension and a smaller left branch too.

We met multiple CRS, there have been 2 broad options advised:

1. Approach 1

Stage 1: With a large incision, lay open the superficial tracts (the ones don't pass through sphincter muscles). Clear out any abscess. If possible tackle the fistula else put a seton and tackle fistula in Stage 2.

Stage 2 (optional): Tackle the trans-sphincteric fistula.

Pros: Possibility to tackle in 1-2 settings.

Cons: More invasive procedure with a larger incision and recovery.

2. Approach 2

Stage 1: Just do I&D of the related abscess and put in a seton.

Stage 2: Fistulectomy only after the fistula hardens. Doc is saying the longer tracts will heal and collapse on their own.

Pros: Less invasive, more sphincter sparing

Cons: Longer timeline and will depend on how the fistula tract naturally heals.

For those with trans-sphincteric fistula, what approach did your CRS recommend and worked for you?

Looking for a proficient and approachable Colorectal Surgeon in Mumbai, India.

Any recommendations from your/ your acquaintances' experience for complex fistula treatment?

Shortlisted a few names from Google...but a personal reference will be great and more reliable

Dr Prajesh Bhuta

Dr Niranjan Agarwal

Dr Chintamani Godbole

Dr Manoj Mulchandani

Dr Mehli Nazir