Colostomy for Fistula in Ano

Role of #Colostomy in #Fistula in ano - the patient had been operated many times for complex fistula in ano After many failed surgery temporary Colostomy was performed to divert stool and few more surgeries were performed to cure fistula. After healing of perineal wound when colostomy was closed patient condition deteriorated. Patient also took different modalities like homeopathy and Ayurveda Kharsutra treatment but nothing worked for him. Pre Surgery MRI scan A complex trans-sphincteric tract extending inferiorly from the anterior aspect of perineum with superior extension showing horseshoe ramification in posterior intersphincteric plane approx 3.4 cm above the anal verge, which shows further branching and extension in left ischio-anal fossa ending blindly at 5 o'clock position. Superiorly, the tract extends and pierces the levator ani muscle on the left side, (approximately 7.5 cm from the anal verge) it pierces the r. internal sphincter at approx 1 o'clock position. ST James University Hospital classification ac Grade V - Supralevatory and translevator with ramifications. - Left sided levator ani appears edematous and left ischiorectal fossa shows inflammatory fc sic changes. Presacral extenisons had signal changes are seen suggestive of extension of inflammation. Subcentimeteric mesorectal lymph nodes are seen.Irregular multiple polpys with Inflammtory changes seen into antero-lateral wall of anal canal and lower rectal canal Treatment planned using Segmental resection Katra technique for fistula in multiple stages without colostomy. Colostomy is not preferred as there is high recurrence rate after closure of colostomy Patient responded very well to treatment comparison Check MRI were preformed during treatment. Dr Ashish Bhanot