1)Fibrin Glue Injection:
Fibrin glue treatment is an effective method of treating fistulae. In this method, the physician first scans the anorectal area using endosonography or magnetic resonance imaging (MRI) and locates the fistula. After this, the fibrin glue is injected into the tract. The fibrin glue activates the thrombin to form a fibrin clot, sealing the fistula tract. Following this procedure, you will be scheduled for follow up visits on weeks four, eight and sixteen to check on the closure of the fistula. Usually, it takes about eight weeks for a fistula to close completely.
2)Video-Assisted Anal Fistula Treatment (VAAFT):
VAAFT is a relatively new and less painful method to treat fistulae. In this procedure, the physician first locates the fistula using a video-assisted probe called a fistuloscope. Then, the fistulae will be removed using an electrode, with a process called fulguration. After fulguration, the dead tissue is removed with a brush. After this, the internal opening is stapled close. The entire procedure will be performed under video surveillance. This is a very simple procedure, where you can go back home the same day, and no wound care is required. Also, there is no bleeding.
3)Interception of Fistulous Tract and Application of Ksharsutra (IFTAK) Technique:
IFTAK is an ayurvedic treatment in which a sterilised metallic probe is coated with a specific set of ayurvedic medicines and is inserted by making a small cut at the perianal site. Thus, on insertion, the medicines coating the metallic probe are carefully released into the tract of the fistula. The collective effect of the coated drugs on the probe cuts the fistula tract and dries the wound. The entire healing of the wound usually takes place in 10 days. The thread must be replaced with a new one every seven to 10 days. Complete healing will occur in four weeks. Overall, each method has its pros and cons, so it is up to you to decide which technique to choose. The Kshar Sutra technique is evaluated and approved by the Indian Council of Medical Research. It is considered to be the most effective and convenient as compared to the other two.[5,6]
Moderate to complex fistulas could be treated using another innovative method that is safe and effective. This method involves the insertion of a customised plug to fit in the fistula tracts. The bioprosthetic plugs are made up of tubes that are plugged inside the fistula tract by an experienced physician. In addition, they have discs on the outer surface that place themselves in the small pockets of tissue that may be present in the fistula tract. The implantation of a bioprosthetic plug to treat complex fistula is advantageous over the surgical options as it can avoid one of the significant side effects of surgery, faecal incontinence.