Fistula Operation in Dhaka: ভগন্দর Symptoms, Causes, Types & 4 Surgical Options | Anorectal Abscess

Fistula Conditions and Treatment in Dhaka

Fistula operation in Dhaka is one of the most frequently performed procedures at Dr. Muhammad Nazrul Islam’s colorectal surgery clinic — and one of the most misunderstood conditions among patients in Bangladesh.

An anal fistula (ভগন্দর / fistula in ano) is an abnormal tunnel connecting the inside of the anal canal to the skin around the anus.

It almost always begins as an anorectal abscess (পায়ুপথের ফোড়া) — a painful collection of pus near the anus — that either bursts spontaneously or is surgically drained but leaves a persistent track behind.

Unlike পাইলস or এনাল ফিশার, anal fistula does not heal on its own — surgery is almost always required. The good news: in expert hands, fistula operation has an excellent outcome with full recovery for the vast majority of patients.

Fistula Meaning in Bengali / ভগন্দর মানে কী?

ভগন্দর (fistula) — বাংলায় এটিকে ‘ভগন্দর রোগ’, ‘পায়ুপথের সুড়ঙ্গ’, ‘মলদ্বারের নালী’ বা কথ্যভাষায় ‘গুহ্যদ্বারের ঘা’ বলা হয়। চিকিৎসা বিজ্ঞানে fistula মানে হলো শরীরের দুটি অংশের মধ্যে একটি অস্বাভাবিক সংযোগনালী বা সুড়ঙ্গ।

Anal fistula (ভগন্দর) specifically means an abnormal tunnel between:

• The internal opening — inside the anal canal (usually at the level of the anal glands)
• The external opening — a small hole on the skin around the anus, which discharges pus, blood or fluid

The term fistula in ano is the formal medical Latin term for anal fistula — it simply means ‘fistula of the anus’. Bangladeshi patients and doctors use both ‘anal fistula’ and ‘fistula in ano’ interchangeably. The Bangla term most widely used is ভগন্দর.

Perianal Abscess and Anal Fistula — The Same Disease, Two Stages / পায়ুপথের ফোড়া ও ভগন্দর

The most important fact about anal fistula that most patients in Bangladesh do not know: perianal abscess (পায়ুপথের ফোড়া / anorectal abscess) and anal fistula (ভগন্দর) are the same disease at different stages. Understanding this connection prevents the most common mistake — treating the abscess but ignoring the fistula that follows:

Causes of Anal Fistula / ভগন্দরের কারণ কী?

The vast majority of anal fistulas in Bangladesh develop from a single root cause. Less commonly, they arise from underlying disease:

Primary Cause — Infected Anal Gland / সংক্রমিত মলদ্বারের গ্রন্থি

The anal canal contains 6–8 small glands (anal crypts) that produce mucus to lubricate stool passage. When one of these glands becomes blocked and infected — usually by faecal bacteria — it forms an abscess. The abscess burrows through surrounding tissue until it reaches the perianal skin, creating the fistula track. This is the cause in approximately 90% of all anal fistulas.

Secondary Causes / অন্যান্য কারণ

• Crohn’s disease (ক্রোনস ডিজিজ) — inflammatory bowel disease causing complex, multiple, atypical fistulas that are notoriously difficult to treat. Fistulas in unusual positions or that fail to heal should raise suspicion of Crohn’s disease.
• Tuberculosis (যক্ষ্মা / TB) — TB of the gut or perianal area is a significant cause of fistula in Bangladesh, where TB remains common. TB fistulas often have multiple tracks and are associated with systemic TB symptoms.
• Radiation damage — from radiotherapy to the pelvis for cancer treatment
• Trauma — including difficult childbirth (obstetric fistula), penetrating injury
• Colorectal cancer — rare but important; a fistula that does not heal after treatment should be biopsied
• Diverticular disease — a perforated diverticulum can fistulise to adjacent structures

Symptoms of Anal Fistula / ভগন্দরের লক্ষণ — How to Recognise It

The symptoms of anal fistula are distinctive once known. The most common presentation at Dr. Nazrul’s Dhaka clinic:

• পায়ুপথের কাছে একটি ছোট গর্ত থেকে পুঁজ বা রক্ত বের হওয়া — persistent discharge of pus, blood-stained fluid or mucus from a small opening on the skin near the anus. This is the hallmark symptom — present in nearly all fistulas.
• মলদ্বারের কাছে ব্যথা ও ফোলাভাব — pain and swelling near the anus, particularly when the fistula becomes temporarily blocked, causing a recurrent abscess
• মলদ্বারের কাছে চুলকানি — persistent itching around the anus due to constant moisture from discharge
• পায়খানার সময় ব্যথা — pain during bowel movement, particularly if the external opening is near the anal margin
• জ্বর — fever, particularly during flare-ups when the fistula track becomes re-infected
• অন্তর্বাসে দাগ — staining of underwear from continuous discharge — a common presenting complaint in Bangladesh
• একটি বা একাধিক গর্ত দেখা যায় — one or more small openings visible on the perianal skin, sometimes with a small firm cord-like track palpable under the skin

Types of Anal Fistula / ভগন্দরের ধরন — Why Classification Matters for Surgery

The classification of an anal fistula — specifically its relationship to the sphincter muscles — is the single most important factor determining which surgical technique is used and what the risk of incontinence is after surgery. The Parks Classification is the internationally accepted system:

Diagnosis / রোগ নির্ণয় — What Happens at Your Consultation

Accurate diagnosis and classification of the fistula tract is essential before any surgical planning. Dr. Nazrul follows ASCRS 2022 guidelines ↗ for assessment:

• Detailed history — duration, previous abscesses and drainage procedures, prior fistula surgery, bowel habit, relevant medical history (IBD, TB, diabetes, immunosuppression)
• External inspection — identification of the external opening(s), surrounding skin condition, any visible tracks
• Goodsall’s Rule application — a clinical rule predicting the likely internal opening based on the position of the external opening
• Digital rectal examination (DRE) — palpation of the fistula tract, assessment of sphincter tone
• Proctoscopy / anoscopy — identifies the internal opening inside the anal canal
• MRI pelvis (fistula MRI) — the gold standard for complex fistulas. Maps the exact course of the tract in relation to the sphincter muscles. Essential before surgery for all but the simplest fistulas.
• Endoanal ultrasound — alternative to MRI for mapping the fistula track
• Examination under anaesthesia (EUA) — sometimes needed for complete mapping when the patient cannot tolerate clinic examination

Fistula Operation in Dhaka: 4 Surgical Options Explained

Surgery (fistula operation) is the only permanent cure for anal fistula. There is no medicine that closes a fistula permanently — antibiotics may suppress infection temporarily but the track remains. The choice of operation depends on the fistula type, complexity and the patient’s sphincter function. Here are the 4 surgical options available at Dr. Nazrul’s clinic in Dhaka. For a general overview, see also the NHS Anal Fistula Guide ↗:

1. Fistulotomy / ফিস্টুলোটমি — The Most Common Fistula Operation

Fistulotomy is the laying-open of the fistula track — the gold standard surgery for low, simple intersphincteric fistulas (the majority of cases in Bangladesh). The entire fistula tract is surgically opened and the wound is left to heal from the inside out (secondary intention healing):

• Cure rate: 90–97% for low intersphincteric fistulas
• Performed as a day-case procedure — no hospital stay required for most patients
• Wound heals within 4–8 weeks
• Risk of incontinence: very low (<1%) for low fistulas
• Not suitable for high or complex fistulas — would risk incontinence

2. LIFT Procedure (Ligation of Intersphincteric Fistula Tract) / লিফট অপারেশন

LIFT is the preferred surgical option for transsphincteric fistulas — those that cross part of the external sphincter. It was developed specifically to cure the fistula while preserving sphincter function:

• The fistula track in the intersphincteric space is identified, ligated (tied off) and divided
• The sphincter muscle is NOT cut — preserving continence
• Cure rate: 70–80% in most series
• Lower healing rate than fistulotomy but much safer for patients with complex fistulas
• Can be repeated if the first attempt is unsuccessful

3. Seton Technique / সেটন পদ্ধতি

A seton is a thread or suture material passed through the fistula track and tied loosely or tightly. It is used in two ways:

• Loose (draining) seton — keeps the fistula track open and draining while the patient recovers or awaits definitive surgery. Reduces inflammation and secondary abscess formation. Used as a first stage in complex fistulas.
• Cutting (tight) seton — gradually cuts through the sphincter muscle very slowly over weeks, allowing fibrous healing as it progresses. Cures the fistula while minimising incontinence risk. Used in selected high fistulas.
• Cure rate: 70–85% depending on fistula complexity
• May require 2–3 visits to tighten the seton over several weeks

4. VAAFT — Video-Assisted Anal Fistula Treatment / ভিডিও-অ্যাসিস্টেড ফিস্টুলা চিকিৎসা

VAAFT is a minimally invasive fistula operation using a small fistuloscope (camera) inserted into the fistula track. It is particularly useful for complex fistulas with secondary branches:

• The fistuloscope visualises the entire track from the inside
• Internal opening is closed; the track is destroyed using electrocautery under direct vision
• Sphincter muscle is completely preserved — no risk of incontinence
• Cure rate: approximately 70–75% — lower than fistulotomy but safest for complex cases
• Not widely available in Bangladesh — Dr. Nazrul can advise whether VAAFT is appropriate for your case

Surgery Comparison / অপারেশন তুলনা

Perianal Abscess Treatment / পায়ুপথের ফোড়ার চিকিৎসা — Urgent Drainage

A perianal or anorectal abscess (পায়ুপথের ফোড়া) is a surgical emergency. The correct treatment is urgent surgical drainage — antibiotics alone are not sufficient and do not cure an abscess:

• Incision and Drainage (I&D) — a small incision is made under local or general anaesthesia to drain the pus. This provides immediate relief and is highly effective.
• The wound is left open to drain and heal from inside out — closing the wound would lead to re-accumulation of pus
• Antibiotics are given after drainage only if there is surrounding cellulitis, the patient is diabetic or immunocompromised, or there are systemic signs of infection (fever, high white cell count)
• After drainage, the patient must be counselled that a fistula may develop over the coming weeks to months — and must return for assessment if discharge persists

Fistula Operation Recovery / ভগন্দর অপারেশনের পর সুস্থ হতে কতদিন?

Post-Operative Care / অপারেশনের পর যত্ন

• Warm sitz baths (গরম পানিতে বসা) — 10–15 minutes after each bowel movement to keep the wound clean and reduce pain
• High-fibre diet and stool softeners (isabgol, lactulose) — essential to keep stools soft and prevent straining. See our constipation treatment guide.
• Keep the wound clean and dry between sitz baths
• Attend all follow-up appointments — incomplete healing is the most common cause of recurrence
• Do not miss follow-up because the wound ‘feels healed’ from the outside — the internal track must heal completely

Fistula vs Fissure vs Piles / ভগন্দর, এনাল ফিশার ও পাইলসের পার্থক্য

These three conditions are frequently confused with each other in Bangladesh. Here is a clear comparison:

Frequently Asked Questions / সচরাচর জিজ্ঞাসা

ভগন্দর মানে কী বাংলায়? / Fistula meaning in Bengali?

ভগন্দর কি ওষুধে ভালো হয়? / Can fistula be cured without surgery?

ভগন্দর অপারেশনের খরচ কত? / Fistula operation cost in Bangladesh?

পায়ুপথের ফোড়া হলে কী করব? / What should I do if I have a perianal abscess?

ভগন্দর অপারেশনের পর কি বারবার হওয়ার সম্ভাবনা আছে? / Can fistula recur after surgery?

ভগন্দরে কি ক্যান্সার হওয়ার ঝুঁকি আছে? / Can anal fistula become cancerous?

বাংলাদেশে সেরা ফিস্টুলা সার্জন কে? / Best fistula surgeon in Bangladesh?

ভগন্দর অপারেশনের পর কি মলদ্বারের নিয়ন্ত্রণ নষ্ট হয়? / Will fistula surgery affect bowel control?

Medical Disclaimer: This page is written for general patient education only and does not replace professional medical advice, diagnosis or treatment. Information is based on ASCRS 2022 clinical guidelines and peer-reviewed medical literature. For personal assessment and fistula operation in Dhaka, please consult Dr. Muhammad Nazrul Islam or a qualified medical professional directly.