LASER TREATMENT OF ANAl FISTULA

A rectal fistula is an unnatural narrow tunnel that is formed in the perianal area as a result of a pathological process. It begins in the rectum and can have only one exit (incomplete fistula), go out near anus (full fistula) or into the lower part of the rectum (internal fistula).

CAUSES OF RECTAL FISTULA FORMATION

In most patients the formation of fistulas is associated with an acute course of paraproctitis. This is an inflammatory lesion of the pararectal tissue, that is, the tissues surrounding the rectum. It develops due to infection process caused by Escherichia coli (column bacillus), Enterococcus, Staphylococcus aureus or other bacteria.

As a result of paraproctitis, suppuration is formed, part of the mucous membrane, muscles and subcutaneous tissues are affected. There is also scarring of tissues at the place where inflammation observed and a shell of connective tissue is formed, which is limiting the area of inflammation. All these factors contribute to the development of anal fistula.

In addition to paraproctitis risk factors for fistula formation include:

• immune system diseases;
• diabetes
• obesity;
• perineal injuries (childbirth, etc.);
• anal fissures and hemorrhoids;
• constipation;
• lack of hygiene;
• sedentary lifestyle.

SYMPTOMS OF ANAL FISTULA

Symptoms of fistula depend on its type and location. At the stage of fistula formation, they are sometimes absent, and the patient periodically feels only discomfort in the rectum and anus. This is also connected with the alternation of periods of exacerbations and remission in paraproctitis.

Symptoms of an anal fistula are:

• formation of a fistula in the perineum;
• discharge of pus, mucus, feces from fistulas (if the fistula comes out) or rectum;
• sensation of a foreign body in the anus (with incomplete fistula);
• redness, inflammation of the skin around the anus;
• painful sensations and itching in the perineum;
• pain in defecating;
• constipation;
• violation of the tone and function of the anal sphincter;
• fever, weakness and other common symptoms of the disease.

WHAT ARE THE FORMS OF ANAL FISTULAS

Fistulas are classified according to several parameters.

According to the presence and the second opening exit location, fistulas are divided into

• incomplete – one entrance hole in the rectum is formed;
• full - there are two exits: one in the rectum and the second outside in the sphincter area;
• internal - both exits are located in the rectum.

Complete fistulas are also divided into anterior, posterior and lateral in relation to the sphincter.

Depending on the location of the fistula in regard to the external sphincter the following types of fistula are known:

• intra-sphincter - fistula is located under the sphincter;
• transsphincteric – fistula affects the sphincter and fiber;
• extrasphincter - fistula is located in the pelvic space and goes out in the perineal area.

There are also 4 stages of extrasphincter fistulas. They depend on the presence of scar tissue, inflammation in the fiber and the presence of purulent foci.

In the absence of timely treatment fistula can cause purulent formations, sepsis, scarring of rectal tissues, weakening of the muscles of the perineum and anus, which in turn leads to fecal incontinence.

DIAGNOSIS OF ANAL FISTULA

A proctologist can diagnose anal fistula during an examination and palpation. To clarify the size of the pathological opening, its location and the presence of concomitant proctological diseases instrumental diagnostics is used.

For the diagnosis of anal fistulas the following methods are used:

• visual external examination;
• palpation of the anus;
• anoscopy, rectoromanoscopy and/or colonoscopy – endoscopic examination of the rectum;
• ultrasound diagnostics;
• fistulography – x-ray examination with a contrast agent (prescribed for extrasphincter fistulas).

NON-SURGICAL TREATMENT OF ANAL FISTULA

Previously treatment of anal fistulas was carried out exclusively by surgical methods. About 10 years ago a new technique appeared. It allows achieving the same effect without surgery. This is a laser thermal ablation of the fistula tunnel. It is actively used in western countries, but in Ukraine the equipment is available at only a few clinics, including «Oxford Medical» clinic.

Laser treatment according to the FiLaC method (Fistula-tract Laser Closure) is effective for all types of fistulas. The procedure is performed under local anesthesia. First, the proctologist cleans the lumen of the fistula, then he affects its walls with laser radiation. As a result, the fistula tunnel is sealed, and over time, connective tissue and an elastic scar are formed in its place.

FiLaC makes it possible to remove fistula without surgical incisions and causing injury to the surrounding tissues. The procedure is almost painless and has a short rehabilitation period. It is carried out on an outpatient basis, but in some cases the patient may need hospitalization for 1-2 days. You can return to normal life in 2-8 days.

Compared to classical surgical methods, FiLaC has significantly fewer contraindications and complications. It is conditioned by the absence of incisions, blood loss and the destruction of all pathogenic bacteria during laser treatment of tissues.

At the «Oxford Medical» clinic laser treatment of anal fistulas is performed on a cutting-to-edge equipment – laser system Biolitec (Germany). It guarantees successful laser operations even if complex forms of the disease take place.