There are some areas of the body which are not only sensitive but of extreme importance. The bowel activity of the body determines the happiness and satisfaction quotient. Any problem in that area disturbs the peace of mind and makes one highly apprehensive.

Fistula in anal is one such issue. Usually there is a prodrome when an abscess forms and it drains outside. Most of the times the fistula is small and superficial but in about 25 percent of patients it can be a high in comparison to the muscles of control.

The treatment of a high anal fistula that too with multiple external opening is highly complex. The main aim is to preserve the control while making a bowel movement and not damaging the muscles and nerves in the area, at the same time avoiding a recurrence of the fistula. It is very difficult balancing act. Several new procedures have been demonstrated in the last few years, like laser treatment, video assisted anal fistula treatment and radiofrequency ablation.

But the success of treatment depends on the judicious use of technology and experience of the surgeon. Adequate investigations and a profound patience on behalf of the patient is a “Must”. People get influence and swayed by the promises of simplistic treatment offered by use of new technology. The provision of laser is just a means. The principles of treatment do not change. The pain and recovery time has to be minimized. “Do no harm” is the motto.

Testimonial of one of our patient who had the problem for 1 year and had 3-4 interventions done starting with VAAFT and then seton and then mucosal advancement flap with complete healing in the area. “all that glitters are not gold”. Prudence is a must.