Fistula Treatment in a 29-Year-Old Truck Driver from Thrissur — Back on the Road Pain-Free

Home Fistula Treatment in a 29-Year-Old Truck Driver from Thrissur — Back on the Road Pain-Free

Anal fistulas are one of the most common yet under-reported conditions among individuals with sedentary or long-sitting occupations. This case study follows the treatment of a 29-year-old lorry driver from Mullurkara, Thrissur, who underwent successful fistula surgery under the care of Dr. Raviram, MS, MCh, a Proctologist in Thrissur with over 16 years of experience in the surgical management of anorectal conditions.

Patient Background and Symptoms:

The patient, Varun, a 29-year-old male working as a long-haul lorry driver, resides in Mullurkara village near Thrissur. For nearly two months, he experienced intermittent pain near the anal region, which worsened while sitting for extended periods during his driving shifts. He also noticed occasional discharge and mild swelling. Due to the nature of his work and long hours on the road, he initially self-managed the symptoms with over-the-counter ointments before the discomfort became persistent enough to seek medical consultation.

Diagnosis of Anal Fistula:

The patient consulted Dr. Raviram for a detailed evaluation.

The following diagnostic steps were carried out:

  • Clinical Examination: A digital rectal examination and proctoscopy revealed an external opening consistent with a fistula tract.
  • MRI Fistulogram: Confirmed a trans-sphincteric fistula tract with no secondary extensions.
  • Assessment via Goodsall’s Rule: Used to correlate the external opening with the likely internal opening location.
Clinical Evaluation and Pre-Surgery Assessment:

Before planning the procedure, a few factors specific to the patient’s profession were taken into account:

  • Occupational Considerations: Since prolonged sitting is unavoidable in his line of work, a treatment option with minimal wound care and faster return to sitting tolerance was prioritized.
  • General Fitness Check: Routine blood work and fitness assessment confirmed he was fit for a day-care/minimally invasive procedure.
  • Bowel Preparation: Standard pre-procedure bowel prep was advised.
Treatment Planning:

Given the trans-sphincteric nature of the tract and the patient’s occupational demands, Dr. Raviram selected Laser Fistula Surgery (FiLaC – Fistula Laser Closure) as the treatment of choice. This sphincter-preserving technique avoids extensive cutting of the anal muscle, reducing the risk of continence issues and allowing faster recovery — a critical factor for someone whose livelihood depends on long hours of sitting and driving.

Fistula Surgery Procedure:

The procedure was completed in under an hour under spinal anaesthesia.

Steps of the procedure:
  • Tract Identification: The internal and external openings were identified and probed.
  • Laser Fibre Insertion: A radial-emission laser fibre was passed through the tract.
  • Controlled Ablation: The laser energy was used to seal the fistula tract from within, destroying the epithelial lining while sparing the sphincter muscle.
  • Curettage: Any residual granulation tissue was gently curetted.
  • Closure: The external opening was left open for natural drainage; no major sutures were required.
Post-Procedure Recovery:
  • Same-Day Discharge: The patient was discharged the same evening with oral pain medication.
  • Wound Care: Sitz baths were advised twice daily for the first week.
  • Return to Work: He was advised to avoid long driving stints for 10 days, after which he gradually resumed his normal driving schedule.
  • Follow-Up: A follow-up visit at 3 weeks confirmed complete healing of the tract with no discharge or recurrence.
Before vs After: Varun's Journey
Patient Outcome:

The patient recovered without complications and returned to full driving duties within two weeks. At his one-month follow-up, there were no signs of recurrence, and he reported no discomfort even after long driving hours.

Conclusion:

Occupational demands like prolonged sitting often delay fistula diagnosis in patients such as truck and lorry drivers, allowing the condition to progress. Sphincter-preserving techniques like laser fistula surgery offer a practical solution for patients who cannot afford extended downtime. Timely consultation with a qualified proctologist remains key to preventing complications and ensuring a full, lasting recovery.

For Fistula treatment in Thrissur, early evaluation by Dr. Raviram, MS, MCh, can help avoid prolonged discomfort and more invasive procedures later.