Perianal Fistula Surgery with Laser
Perianal Abscess and Fistula

What Is It?

An abscess occurs in case of progressive infection as a result of blockage of the opening of the glands in the rectal area. In particular, the connection of the gland with the intestine triggers recurrent abscess formation. This condition is called Perianal Fistula.

Who is it commonly seen in?

It is seen in 1 in 10.000 people in the society. Proctological diseases are common especially in occupational groups working in a seated position. It is common in desk workers such as pilots, drivers, cashiers, secretaries. Breech area disorders, i.e. proctological diseases, are also associated with obesity. It is more frequent and persistent in individuals with more adipose tissue, the treatment process is longer and difficult to manage.

What are the symptoms?

The most common symptom is discharge from the anus and pain. Perianal fistula diagnosis should not be forgotten especially in non-healing or recurrent abscesses. If the abscess is opened to the skin and not emptied, it causes redness and fullness.

How is the diagnosis made?

Abscess is usually diagnosed by physical examination. In advanced abscesses and fistulas, the tissues and volume of the lesion should be evaluated by MRI. MR imaging is necessary for the classification of the fistula. We surgeons choose the type of surgery we will perform according to this classification. Endoscopic examination should not be forgotten in each case, especially in case of long-term discomfort in the anus. A cancer may occur at any time following proctological problems.

How is the treatment done?

Simple abscesses are drained under local anaesthesia. Since there is a lot of pain in abscesses close to the anus or in the anus, spinal anaesthesia is used instead of local anaesthesia. After the abscess is drained, it is checked whether there is an underlying perianal fistula.

Fistula surgery varies according to classification. The disease is classified according to its relationship with the muscles that hold the large ablution in the anus. In some types, if the muscle group is affected, both openings are passed and tied with a rubber or suture material called seton. The operation is performed by sensing the trajectory of the fistula with a guide flexible wire called stylet. In this way, the muscles are minimally damaged. Even in this case, gas leaks can be seen though rarely.

The fistulotomy procedure aims to determine the inner and outer opening and to completely remove the tissue between them with surgery. Although the success rate of up to 97% seems very good, the most serious side effect is the damage to the ability to control large ablution as a result of partial damage to the muscles.

Although different methods such as tissue adhesives, tissue advancement surgery with PLUG method, synthetic stoppers have been tried, success rates have been found to be low. Many centres have abandoned these methods.

What is Laser Treatment?

Laser treatment method, which is used for burning the tissue with heat effect, namely ablation, is the most up-to-date surgical method. In the laser method, where the tissues are least affected and the patient is treated with the least pain, the short hospital stay and early return to work maximise patient satisfaction. There is a risk of recurrence of the disease in the presence of abscess and multiple fistulas. In such cases, laser should be tried after abscess drainage or after seton application.

Post-treatment Follow-up and Diet

Whether the treatment method is surgical or laser, the patient is called for a follow-up on the 3-5th day after the procedure. Hygiene of the area after discharge is also important in terms of infection and the risk of recurrence of the disease. A special diet should be arranged for the stool to be soft, and the patient should be provided to have a painless defecation.

What is the Chance of Recurrence?

Recurrence and fistula development up to 50% are observed in anal abscesses. The reason why there is no clear rate for fistula treatment is that the classification of the disease, the treatment method applied, the presence of accompanying abscess, the length of the fistula and its relationship with the muscle and the number of fistulas are factors that directly affect the possibility of recurrence. Roughly 10-50% chance of recurrence can be mentioned.

How long does the treatment last?

In simple abscess drainage, work is resumed the next day. In fistula patients, treatment may be prolonged for 2-4 weeks if no seton is applied and up to 2-3 months if seton is applied.

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