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LASER SURGERY FOR ANAL FISTULA
Minimal Pain
No Stitch
No Scar
30 Min Procedure
LASER SURGERY FOR ANAL FISTULA
Minimal Pain
No Stitch
No Scar
30 Min Procedure
What is Anal Fistula?
Causes Of Fistula
• Anorectal abcess – Almost all anal fistulas are a result of a preceding anorectal abcess. An anorectal abcess begins as an infection of one of the anal glands. The infection soon forms a pool of pus – abcess. An anal fistula results when the abcess fails to heal completely with/without treatment.
•Infections:Tuberculosis, HIV, sexually transmitted diseases
Symptoms Of Anal Fistula?
An anal fistula usually results from an injury to the tissue lining the anal canal or an infection in that area. It may occur as a result of :
- Throbbing pain that worsens on sitting
- Swelling, tenderness, itching or redness around the anus
- Discharge of pus, blood and debris which is usually foul smelling
- Pain associated with bowel movements
- Fever
Causes Of Fistula
INTER-SPHINCTERIC
Track in the space between the two anal sphincters
TRANS-SHINCTERIC
Track passes through both the sphincters
SUPRA-SPHINCTERIC
Track loop over the sphincters and passes through the pelvic floor muscle
EXTRA-SHINCTERIC
Track from rectum to perianal skin without involving sphincters
Diagnosis Of Anal Fistula | Bhagandar
Usually a brief history followed by clinical evaluation – including a digital rectal examination is enough to diagnose an anal fistula.
- At the same time Proctoscopy ( a minor inspection of the rectum using a small tube like scope ) is also done to check for any concomitant condition in the rectum.
- An MRI Fistulogram may be needed for complicated fistulas in which the tract is difficult to delineate.
- Fistulography, an X-Ray of the fistula after injecting a contrast solution is not done any longer as it may lead to the formation of a false tract due to forceful injection of the dye.
Treatment for Anal Fistula l Bhagandar
Anal fistula does not heal completely on its own, surgery is necessary to treat it.
Fistula treatment techniques are now divided into two categories:
- Traditional open surgery
- Laser surgery of Anal Fistula
1. Traditional open surgery
- Fistulotomy:This is the most common and effective treatment for patients with simple fistulas. In this procedure, the surgeon cuts off the whole length of the fistula so it can heal as a plain scar. It is generally an outpatient procedure. You can go home the same day.
- Seton techniques: In this procedure, the surgeon tightened the fistula with the help of a suture or rubber band. It heals the fistula behind the seton and also lowers the risk of incontinence. Recommended for long, complex and high fistulas.
2. Laser surgery of Anal Fistula
How is laser treatment for anal fistula performed?
(A). FiLaC ( Fistula-tract Laser Closure )
The aim of the procedure is to gently remove the fistula tract without damaging the sphincter muscle
The procedure is done under short General Anaesthesia and requires about 30-40 minutes. A radially emitting Laser Fibre is inserted from the outside. A defined amount of laser energy is then emitted circumferentially into the fistula tract. The laser energy causes controlled photothermal destruction of the fistula tract causing it to collapse to a high degree. This also helps supports and accelerates the healing process.
Advantages of FiLaC
• It has an excellent healing rate as compared to all other techniques.
• The anal sphincter is preserved so there is no risk of post-operative incontinence.
• It can be done in complicated fistulas like recto-inguinal, recto-gluteal fistulas.
• It is safe in high risk patients like those with hypertension, cardiac ( heart ) problems and in senior citizens.
(B). Distal Laser Proximal Ligation ( DLPL )
Fistula is a complex disease. Ultimately the aim of any fistula treatment is not just to get rid of the existing fistula but:
- To save the sphincter muscle and thus prevent incontinence.
- To prevent recurrence, considering the nature of the disease
(C). LIFT-ligation of the intersphincteric fistula tract
It is a new technique for fistulas associated with anal sphincter muscles. Here the skin above the fistula is opened, the sphincter muscles are pushed apart and the internal opening of the fistula is ligated (tied off)with a suture. The infected tract is then removed and the wound is cleaned and scraped thoroughly. This procedure can be used as a second stage for the seton technique
Benefits of laser treatment for anal fistula
| POINTS | CONVENTIONAL SURGERY | LASER SURGERY(FiLaC) |
|---|---|---|
Hospital Stay |
3-5 Days |
Daycare/24 Hours Stay |
Pain |
Intense 3-4 week |
Painless |
Bleeding During Surgery |
Moderate |
Bloodless |
Ability to sit after Operation |
No/Difficult sitting for 4 weeks |
Can Sit From 2nd Day |
Wound |
Moderate to Large |
No Obvious Wound |
Healing |
2 Months Approx |
Few Days |
Medication |
Long Course |
5-7 Days |
Anal Stenosis |
Yes |
No |
Relief of Constipation after surgery |
No |
Yes |
What is the Recovery Process of Anal Fistula Laser Operation?
Laser treatment for fistula recovery is very quick and comfortable. As it is a minimally invasive daycare procedure, the patient can go home the same day of the surgery.
- Patient can resume daily activities after 2-3 days of the surgery.
- Do not perform any strenuous activities until the doctor suggests.
- Although there are no diet restrictions, follow the diet chart given by the surgeon for a few days after the fistula laser surgery.
- Contact the doctor immediately if you notice something unusual.
What To Do After Anal Fistula Surgery?
- Follow your doctor’s instructions: Your doctor will give you specific instructions on how to care for the wound after surgery. Follow these instructions carefully to prevent any complications and promote healing.
- Take medicines on time: After surgery, you may experience mild pain and discomfort. Your doctor may prescribe over-the-counter medication to help you manage the pain. Make sure to take the medication as directed and inform your doctor if the pain persists or worsens.
- Keep the wound clean and dry: It is crucial to keep the surgical wound clean and dry to prevent infection. Your doctor may give your some instructions on how to clean your surgical site.
- Avoid strenuous activity: Avoid strenuous activity for up to 1 week after the surgery. Strenuous activities can put pressure on the wound and slow down the healing process.
- Eat a healthy diet: A healthy diet can help you recover faster after surgery. Include foods that are rich in vitamins and minerals such as fruits, vegetables, and lean proteins.
- Attend follow-up appointments: Attend follow-up appointments with your doctor to monitor your progress and ensure that your wound is healing properly.
- Stay hydrated: It is essential to stay hydrated after surgery. Drink plenty of water and avoid caffeinated and alcoholic beverages.
FAQs Around Anal Fistula Treatment
Usually, anal fistula can’t heal on its own. Surgery is the best and most effective treatment option to cure an anal fistula. The doctor will suggest the best surgical option based on the severity of the condition.
Anal fistula surgery is performed under the influence of anesthesia so you won’t feel pain and discomfort during the procedure. The doctor may suggest over-the-counter medications to manage the post-operative symptoms.
The main cause of anal fistula is an infection or abscess in the nearby tissue. When the abscess doesn’t heal completely, it can lead to a tunnel or fistula forming between the skin and the inside of the body. Other causes include trauma, surgery, or certain diseases like Crohn’s.
No, anal fistula laser surgery is a minimally invasive procedure that can be performed on an outpatient procedure, meaning you can return to your home on the same day of the procedure.
Here are some common side effects of the anal fistula laser surgery includes:
- Post-operative pain and discomfort
- Bleeding
- Infection at the surgical site
- Swelling
