Wednesday, 23 January 2019


Brief reference to Fistula-in-ano was mentioned in the Code of Hammurabi even
as early as 12th century BC.
Hippocrates (400-365 BC) thought that the trauma and abscess were the causes of
fistula. He advised early drainage of an abscess even open while still unripe to prevent
fistula formation. Various forms of treatment were used in fistula. The non-operative
procedures of ligation using horse hair and raw lint was given as the method of choice in
the majority of cases. If ligation failed then surgical procedure of cutting down on the
tract was directed. The wound is to be allowed to heal by granulations from the bottom.
The use of the syringe and caustic substances are advocated to distend the tract.
Celsus (25 BC-50? AD) performed the ligature after having accomplished a total
excision of the superficial plane and the only incision which is interrupted in its central
part is performed by following a probe. He pointed out the dangers of incising to a high
internal opening and used a tent in such cases. The modern fistulotomy in 2 stages and
fistulectomy are repetitions of Celsus’s treatment.
Heliodorus (c. 1st century AD) and Antyllos (c. 150 AD) in Rome performed the
incision by following a flat probe.
Galen (130-200 AD) treated fistulas with drainage and chemical cauterisation.
Leonidas of Alexandria (c. 200AD) and Aetios of Amida (502-575 AD) performed the
incision after previous ligature and pulling with a folded probe.
Paul of Aegina (625-690 AD) used a bent bistoury and left the Hippocratic
ligature for fearful patients.

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