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How to prevent recurrence of Perianal Abscess/ heal Fistula in Ano?

Good evening Doctors, I, myself, a 3rd yr Medico, am the case here. 22 yr/M had a h/o Perianal swelling in Jan 2020. On examination by a Surgeon, it was found to be Perianal Abscess at 7 'O clock for which I subsequently underwent I&D. Culture report of the pus has been attached. Now, I again experienced similar complaints of Perianal swelling and pain at the same spot, after which I started taking Sitz bath. The abscess, this time, broke by itself after 5 days of Sitz bath. I then, later met the Surgeon. The Surgeon, now, highly suspects the presence of a Fistula in Ano at the spot. He suggested me to wait for another turn of swelling there and if it recurs, he adviced MR Fistulogram and subsequently a Fistulectomy. He also gave Tab Metronidazole and Painkillers. Respected Doctors, Can you please suggest if there is any way to prevent the recurrence of Perianal abscess (or) if there is a way to Heal the fistula without a Sx? If there is recurrance again, what are the best treatment options?

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Dear Arvind, There is no doubt that you have developed perianal fistula Unfortunately, it can not be cured by medical management or medicines. Surgery is a must to get rid of fistula in ano The biggest problem is 1) Complete removal of fistula so that there is no recurrence 2) Preservation of perianal sphincter to avoid incontinence Both these point are crux of fistulectomy surgery, Please take help of senior and experienced surgeon to achieve both these objectives

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Dear Arvind it seem to me you have developed a perianl fistulae , in generally it is out of 50% of pt who has undergone incision for perianal abscees . After incision of perianal abcess proper dressing reqired and wound heel from the depth but many a time the mouth of the cavity closed and after few days there is collection pus in cavity and automatical burst out and the process goes on until fistulectomy done , before that fistulogram to see the extent of the fistula which will help during operation

Thank you very much for the response sir!
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Dear Arvind, There is no doubt that you have developed perianal fistula Unfortunately, it can not be cured by medical management or medicines. Surgery is a must to get rid of fistula in ano The biggest problem is 1) Complete removal of fistula so that there is no recurrence 2) Preservation of perianal sphincter to avoid incontinence Both these point are crux of fistulectomy surgery, Please take help of senior and experienced surgeon to achieve both these objectives

Thank you very much for the response sir!
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Congratulations! Your case has been selected as Case of the day and you have been awarded 5 points for sharing the case. Keep posting your interesting cases, Happy Curofying!

Thank you doctor
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Recurrent perianal fistula can also be due to IBD. Better to do a colonoscopy. What was the report of MR fistulogram. Complex fistula is more in favor of Crohn's disease. If that is the etiology, then you may need biologicals like infliximab.

Thank you for the response sir! MR Fistulogram is not yet done. Surgeon recommended it the next time a swelling appears at the Perianal spot which would be followed by Fistulectomy. The present abscess had burst and subsided. Sir, my surgeon also recommended VAAFT surgery for Fistula in Ano for the next time. Which according to you would be better, Fistulectomy or VAAFT or any other procedure?
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Perianal fistula Recurrence are common Change in lifestyle Avoid fast junk and nonvage completely forever Add plenty of fibre diet salad green leafy vegetables Surgery is best option Anometerogyl oint twice daily Antibiotics as per high sensitivity Avoid long sitting hours

Thank you very much for the advice sir! I am a big fan of ur Diagnosis in several Curofy cases. Thank you for ur contribution to the community! It encourages budding doctors and medicos to follow ur path!
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Repeated abscess chances of fistula increases Do hb1ac Idealy in theater methylene blue is injected then explore Sample is to r/0 tuberculous or malignancy Alternative mri fistulogram Or 02 bd 5 days Homeopathy silicea30 pills chew tds excellent results

Thank you very much for the response sir!
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Dear Second Most of the perianal abscess subsequently develop Fistula in ano There are various types of fistula in ano There are various modalities for treatment of fistula in ano .Even in the best of hands recurrence of Fistula is 10 percent. Fistula in ano is sometimes associated with Chrons,Koch's, malignancy which needs to be managed

Thank you very much for the response sir! My surgeon also gave option of performing VAAFT for Fistula closure. What is ur opinion on that sir? Which is better, Fistulectomy or VAAFT or any other procedure?
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NEED'S.. FISTULECTOMY.. BS..ANTIBIOTICS AS PER .. SENSITIVITY..EXAMINATION.. SYMPTOMATIC T/T.. FOLLOW UP WITH SURGEONS OPINION..

Thank you very much for the response sir!
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Very difficult issues, Fistulectomy is recommended, perineal hygiene. I had some where read milking may be non surgical approach in non operable non infective non extensive cases. I may be wrong . Surgeons are better advisor.

Thank you very much for the opinion sir!
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VAAFT Isthe latest modality of treatment Results depend on the expertise of the surgeon

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