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Anal fistula is a chronic phase of anorectal sepsis and is characterized by chronic purulent discharge or cyclical pain associated with abscess formation, followed by intermittent spontaneous decompression. A fistula-in-ano is a hollow tract lined with granulation tissue, connecting a primary opening inside the anal canal to a secondary opening in the perianal skin. Secondary tracts may be multiple and can extend from the same primary opening. Normal anatomy includes small glands just inside the anus. Occasionally, these glands get clogged and potentially can become infected, leading to an abscess. The fistula is a tunnel that forms under the skin and connects the infected glands to the abscess. Anal canal glands situated at the dentate line afford a path for infecting organisms to reach the intramuscular spaces. A fistula can be present with or without an abscess and may connect just to the skin of the buttocks near the anal opening. Other situations that can result in a fistula include Crohn's disease, radiation, trauma and malignancy. Goals of treatment - 1. To eliminate the primary fistula opening, any associated tracts. 2. To eliminate secondary openings. 3. To prevent / minimize recurrence. 4. To retain continence. 1. Fistula tract tracing by using fistula probe inserted through the external opening with special emphasis on location of the internal opening. 2. Tract curettage with special emphasis on intersphincteric tracts. 3. Through washing of the tract with hydrogen peroxide & betadine solution. 4. Closure of the internal opening with Vicryl 2/0 (Ethicon) stitches. 5. Injection of adipose derives stem cell suspension through a long fine needle into the tract walls, with half of the total cells being placed in the intersphincteric tracts & those adjacent to the internal opening and the other half being placed in the tract walls in the direction of the external opening. 6. Sealing of the fistula tract with fibrin sealant. Signs or symptoms of fistula - � Perianal pain, � Redness or swelling around the anal area � Excoriation at the tract site � Fatigue, general malaise, as well as accompanying fever or chills are also common. ADSCs have anti-inflammatory and regenerative effects & post infusion they come into contact with pro-inflammatory cytokines, such as IFN- gamma, which is produced by the inflammatory environment. ADSCs deliver immunoregulatory signals that suppress inflammation, allowing the fistula tract to heal. Once inflammation is under control, fistulas can heal like normal wounds. Learn More at www.stemrx.in