Fistula is nothing but a hollow tube or sinus or a track (generally defined as an abnormal passage between two epithelium). Fistula in ano is more common in males to females, the ratio is believed to be 7:2.
Understanding Fistula in Ano
Fistula in Ano is a granulated track communicating between perianal skin superficially to anal canal or rectum.
Fistula in Ano can be Cryptoglandular resulting from inflammation of proctodeal glands or Non-cryptoglandular resulting from Tuberculosis, Crohn’s disease, Ulcerative colitis, Hydradenitis Suppuritiva, Injury, Iatrogenic cause or Carcinoma.


Fistula in Ano is classified (Park’s Classification) in to four, based on the location of the track
• Inter Sphincteric Anal Fistula
• Trans Sphincteric Anal Fistula
• Supra Sphincteric Anal Fistula
• Extra Sphincteric Anal Fistula
Another classification is based on the location of internal opening of the Fistula Track
• Low Level Anal Fistula - They open into the anal canal below the Anorectal ring.
• High Level Anal Fistula - They open into the anal canal at or above the Anorectal ring.
Common symptoms of anal fistula include
- History of Anorectal abscess
- perianal discharge ( purulent / bloody discharge )
- Pain
- Swelling / Lump
- Skin excoriation
- Itching
How MAC treats Fistula in Ano
A special formulated thread / seton known as Kshara sutra prepared as mentioned in Sushruth Samhita. It is prepared by coating surgical thread with various medicinal plants such as Snuhi (Euphorbia nerifolia), Apamarga (Achyranthes aspera), Haridra (Curcuma longum) etc.
This alkaline thread is tied around the fistulous track which cuts, curettes, drains and heals the fistulous track.
Advantages of treating at MAC
- No fecal incontinence
- This is ‘surgery without knife’
- Huge wound can be avoided
- Short stay at Hospital
- Much economical
- Can do everyday activities
- Negligible recurrence
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