Brief Answer:
Please provide further information

Detailed Answer:
Hi.
Thanks for your query.

Read and understood your history about the anal fistula and problems related to the cervical area like disc, kyphosis, osteophytes.

First of all I would like to know the details, please provide for me to know the details so that I can help you more.

May I please know what are the steps your Surgeon told you so that I can elucidate you more ?
Since when the fistula has been present ?
Any investigations done till now ?
These are Colonoscopy , Fistulogram by conventional method or by MRI, biopsy or any other. These are necessarily done before the surgery to know whether the fistula is high anal or low anal, the decision taken depending upon the placement of the internal opening - whether above the internal sphincter or below the internal sphincter.
This is the most deciding factor in deciding the type of Surgery one would have to go through.
The internal sphincter has to be saved at any cost as the continence or incontinence depends upon this internal sphincter.

You may please post the reports or the pictures as an attachment to this query as YYYY@YYYY

Since you have been told that the surgery will be done in three stages, I can think of this to be ''high anal fistula'', meaning above the internal sphincter.

There are few different kinds of surgeries done in high anal fistula.
Out of all these what is the preference your Surgeon can not be understood by me unless you tell me what your Surgeon told or explained. This will give me some idea to tell you the details.

Yes, I can tell you the different types that different Surgeons adopt.
- Some surgeons prefer to do in three stage, if the fistula is of ''High Type''.
The first stage is to colostomy to bypass the anus of the feces full of bacteria.
In second stage then they would Excise the whole fistula tract and restitch the internal sphincter.
In the third stage, Once this anal wound is healed colostomy is closed.

-If the anal fistula is of ''low type'', this is a single stage surgery, where either the tracts is laid open to allow to heal or the tract is excised in toto.

- Some surgeon prefer to put seton or a thread the fistula tract and tie it outside the anal canal and allow or instruct you to tighten it so that it slowly cuts the internal sphincter in such a gradual way that only a very small part of internal sphincter is cut and at the same time the previous cut is healed to maintain the integrity of the Sphincter. This way the internal sphincter is saved and the tract is also healing. Ayurvedic Doctors put a thread of ''ksharsutr''- specially medicated thread that cuts the tract and at the same time the healing is occurring from above downwards so that the sphincter is saved and then there is no chance of incontinence.

The dangers:
The biggest danger is incontinence- occurs only if the internal sphincter in inadvertently cut through and through. as a single cut, that no surgeon with the knowledge would do.

It is imperative that the biopsy is done before or after surgery as there is a chance to know if the primary reason is like tuberculosis or Crohns. There are chances of recurrence.

Long duration of healing, the inconvenience attached to it may be lost working days.

I have tried my best to make it as simple as possible and also hope this answers your query at least in part. Your giving me more details can help me to explain you more.

Please feel free to ask for more relevant questions or if you feel there is a gap-of-communication. I will be very happy to assist you. I know the Fistula-in-ano can be very tricky sometimes.

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Brief Answer:
A good preoperative work-up

Detailed Answer:
Thanks for your appreciation.

Yes, Fistula-in-ano is a diagnosis where the Surgeon and the patients both have their own concerns.

Is the Surgery dangerous > In the hands of the expert Surgeon and the one who is conservative and wants to first evaluate the status of the disease, surgery would be absolutely safe. Unless the Internal Sphincter is cut through and through there is no chance of any incontinence. So you have to find one like this.

Leaving it alone:
Surely not. As this is a ''focus of infection'' troubling all the time, closing to give false hope once and opens up with a swelling the other time, and that too at a time when you should be really be fit.
Secondly, we should know the histo-patho diagnosis to confirm that it is not due to any specific disease like Tuberculosis or Crohns or so. Only biopsy can be done for this. But when you are operated , we get a large specimen to give better diagnosis.
Thirdly, it could get worst: with the time, it can open up many more channels in nearby tissues as this is the area almost always under pressure.

Incontinence at the hands of a good surgeon is not known. So please do not worry about it. And this is not possible if the fistula is of ''LOW Anal '' variety as it is already below the internal sphincter hence no chance of trauma.

So a good preoperative work-up is very very important.
By the way, where do you stay - which country / city ?

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Brief Answer:
Fistulogram or which investigations ?

Detailed Answer:
Thanks for your feedback.
Constipation is causing more problems, which in turn can be caused by the medicines you take for the neck and back problems.
It is good that colonoscopy and barium study has been done, There may be Diverticular disease. And it is good that you do not have Crohns.

The ultimate question still remains:
What is the type of the fistula- High or low anal ?
And the deciding factors / investigations done to prove the point ?
Is it by seeing the internal opening or by a Fistulogram ?

Please let me know these points.

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Brief Answer:
Most welcome

Detailed Answer:
Sure, Indeed.
Awaited.

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Brief Answer:
Repeat Lipid Profile after overnight fasting and avoids fats for a few days

Detailed Answer:
Gone through your all the reports.
Cholesterol is definitely high, but this should be done after overnight fasting for the correct interpretation of the results. Please repeat the Lipid profiles after overnight fasting and avoid fatty foods for a few days for you to get the proper results and then only it is possible to think about the results.

I have seen people going into more anxiety and stress just because there are altered reports; I hope you would agree with me.
So do not worry at the moment, repeat the tests as advised.
And more important are many other factors, like stress, anxiety, lifestyle, exercises, food habits, hereditary factors, BMI- a calculation on the ratio of height and weight, belly fat and girth and so on , the list is unending.

I hope this helps you.

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Brief Answer:
Sure.

Detailed Answer:
Sure Madam.
You are most welcome for further discussion.

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