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New procedure to treat Complex Anal Fistula

Chandigarh: Dr Pankaj Garg, a colorectal surgeon based in Chandigarh, has invented a new operation, termed as ‘PERFACT Procedure’, to treat complex and highly complex anal fistula.

Dr Pankaj Garg
Dr Pankaj Garg

Complex anal fistula is a dreaded disease notorious for its high recurrence rate, the risk of incontinence and potential to turn into malignancy in long term.

According to Dr Garg, though several options are available for simple anal fistula, there is no good treatment available for complex anal fistula. Few procedures like VAAFT (Video Assisted Anal Fistula Treatment), LIFT (Ligation of Intersphincteric Fistula tract), Anal Fistula PLUG (AFP) or GLUE have been tried over the last few years, yet the quest for a better procedure is on throughout the world.

“PERFACT Procedure (Proximal superficial cauterization, Emptying Regularly of Fistula tracts And Curettage of Tracts) is a minimally invasive procedure associated with minimal pain and minimal (less than a day) hospital stay,” says Dr Garg.

“Its cure rate is much better than any of the known methods used to treat complex anal fistulas. There is no risk of incontinence (losing the control over motions) after this operation, as the sphincters are not cut at all. The success rate (cure rate) of this procedure is also quite promising (up to 87%),” he says.

The procedure entails two steps: superficial cauterization of mucosa at and around the internal opening and keeping all the tracts clean. The principle is to permanently close the internal opening by granulation tissue. This is achieved by superficial electrocauterization at and around the internal opening and subsequently allowing the wound to heal by secondary intention. Along with this, all the tracts are curetted and it is ensured that they remain empty and clean in the postoperative period until they heal completely. The latter step also facilitates the closure of the internal opening by preventing collected fluid in the tracts from entering the internal opening and thus not letting it close.

“This procedure has brought new hope for the perennially suffering patient of Complex Anal Fistulas and may change the way the disease is treated,” Dr Garg adds.

According to Dr Garg, the PERFACT Procedure was presented last year at the annual conference of the American Society of Colon and Rectal Surgeons (ASCRS) held in Miami, Florida, USA on May 21, 2014. This year also, Dr Garg has been invited to give special presentation – ‘Presentation of Distinction’ on ‘Garg PERFACT Procedure’ at the annual conference of ASCRS on June 1, 2015 at Boston, Massachusetts, USA.

A paper on PERFACT procedure has been published in the World Journal of Gastroenterology.

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