Emergency Number


September 11, 2015


General Surgery


Fistula in Ano or Anal Fistula is a small channel that develops between the skin near the anus and the bowel. It is a morbid and difficult to treat disease. The lack of understanding and fear of fecal incontinence leads to hesitant conservative attempts at dealing with the patients. This further aids to the recurrences The long-term painful recovery, being out of job tempts the patients to opt for unscientific ways where the un-qualified quacks give them false assurance. The symptoms of this conditions are as follows

  • Pain, worst when sitting
  • Fever
  • Constipation
  • Skin redness around the anus, along with irritation, and swelling

Currently, Laying open the tract or Seton placement are the treatments that are widely used to treat anal fistula. Although, minimally invasive methods like; VAAFT ( Video Assisted Anal Fistula Treatment) and LIFT (Ligation of Intersphincteric Fistula Tract) are also developed, but, are very costly due to the technology involved and technically demanding. Not all can do or teach it. There was a need for a minimally invasive method which is cost effective and easy to reproduce.

SLOFT (Submucosal Ligation of Fistula Tract) has come up as a practical solution. It is very simple operation. It doesn’t need any advanced technology. This was started in Jan 2014. Till now 80 cases have been operated with recurrence in only 7 cases. More than a dozen centres have adopted it in our knowledge, after either a single demonstration or only seeing the video clip on Youtube. No post-op wound packing or dressings are required. Only sitz bath and application of petrolatum jelly by the patient himself. Weekly follow up, till the wound heals.


Under the effect of low spinal anaesthesia, the internal opening is defined. Gently a pliable probe is passed through the external opening and taken out of the anus. A small incision given near internal opening, little dissection is done around the probe and an aneurysm needle passed to take suture around the indwelling probe. Probe removed and suture tied flush to internal opening. Tract transacted and distal component cored out. Anal wound closed. The external wound is left open.

We have operated 80 cases in 13 months with the mean follow up of 4 months. Recurrence is seen in 7 cases with minimal morbidity. There is no incontinence in any case.

Advantages of SLOFT

  • It can be done in acute cases also where tract is not formed, hence LIFT is not possible
  • Better economy wise, as compared to Fistula plug and VAAFT
  • It is now being combined with VAAFT to save the cost of stapler to close internal opening

There is always a need for a procedure which is easy to learn and teach, has early recovery and is cost-effective. SLOFT has all those advantages

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