Before diving into laser fistulectomy, it is important to understand what a fistula is. Simply speaking a fistula is an abnormal connection like a tunnel forming between two parts or organs of the body. When it happens in the area around the anus, it is known as an anal fistula.
Living with anal fistula can be quite troublesome. Common symptoms include painful and swollen anus, pus or blood coming from the opening of the fistula, irritated and itchy skin around the anus and sometimes fever. If you experience these symptoms, it is important to visit a surgeon. They can diagnose the issue and recommend the best treatment.
Laser fistulectomy is a modern surgical procedure used to treat fistulas. Traditional surgery involves cutting out the fistula tract, which can be very painful and requires a longer recovery period. In contrast, laser fistulectomy employs a laser beam to remove or close the fistula, offering a minimally invasive alternative.
The surgery is performed under general anesthesia. A small, flexible laser fiber is inserted into the fistula tract. The lasers energy precisely targets and removes the abnormal tissue or seals the fistula. The laser helps in reducing bleeding and promoting quicker healing by sealing the blood vessels and tissues.
There are several benefits of opting for laser fistulectomy over traditional surgery. This procedure involves less cutting and minimal damage to the surrounding tissues. Patients generally experience less pain after the procedure. Recovery is usually faster, allowing patients to return to their normal activities sooner. The precision of the laser reduces the risk of post - operative infections. Many laser fistulectomies can be done on an outpatient basis, meaning you can go home the same day.
Before the Procedure: You’ll have a consultation with your doctor to discuss your symptoms and medical history. A physical examination and possibly some imaging tests will be done to understand the fistula’s exact location and complexity. Your surgeon will guide you on how to prepare for the surgery.
During the Procedure: You’ll be given either local or general anesthesia depending on the complexity of the fistula and the recommendation of your surgeon. The surgeon will use a laser fiber to treat the fistula. The whole process typically takes about 30 to 60 minutes.
After care: After the surgery, you’ll spend some time in a recovery room where medical staff will monitor you. You might be given pain medication to manage any discomfort. During discharge from the hospital you will be advised on how to care for the surgical site, including hygiene tips, activity restrictions and medications. A follow-up appointment will be scheduled to ensure proper healing and to check for any complications.
Risks and Complications: Like any medical procedure, laser fistulectomy carries some risks, although they are generally lower compared to traditional surgery. Some bleeding might occur, but it is usually minimal. Although the risk is lower, there is still a possibility of infection. There is a chance that the fistula might come back, requiring further treatment. A few patients may experience pain, but it tends to be less severe than with traditional surgery.
Laser fistulectomy is an effective treatment for many people with fistulas, but it is not suitable for everyone. Your doctor will evaluate your specific condition and medical history to determine the best treatment option for you.
Simple fistulas are more easily treated with lasers than complex ones. Your general health and any underlying conditions will be considered. If you’ve had treatments before, your doctor will take that into account.
Finally, Living with a fistula can be quite challenging, but modern treatments like laser fistulectomy offer hope for effective and less painful solutions. If you think you might have a fistula, don’t hesitate to seek early medical advice. With the right treatment, you can get rid of your fistula problem and get back to feeling your best.
What is an anal abscess?
An anal abscess is an infected, pus-filled cavity, located near the anus or rectum.
What is an anal fistula?
An anal fistula, often the result of a previous abscess, is a small tunnel that connects the anal gland, from which the abscess originated, to the skin around the anus.
What causes an abscess?
An abscess arises from an acute infection of a small gland just inside the anus, due to the entry of bacteria or foreign material into the gland. Certain conditions, such as colitis or other intestinal inflammation, can sometimes make these infections more frequent.
What causes a fistula?
After an abscess has been drained, a canal that connects the anal gland from which the abscess originated to the skin may persist. If this happens, the persistence of secretion from the external opening may indicate the formation of the fistula. If the external opening of the canal heals, a recurrent abscess may develop.
What are the symptoms of an abscess or a fistula?
Symptoms of both ailments include pain, sometimes accompanied by swelling, not necessarily related to evacuations. Other symptoms are irritation of the skin around the anus, secretion of pus (which often relieves pain), fever, and generally feeling unwell.
Does an abscess always become a fistula?
No. A fistula develops in 50% of all abscess cases, and there is no way to predict whether this will happen or not.
How is an abscess treated?
An abscess is treated by draining the pus of the infected cavity, creating an opening in the skin near the anus relieves tension. Antibiotics are usually not an alternative to pus drainage, because antibiotics are carried by the blood and do not penetrate the liquids into the abscess.
Should a fistula always be operated on?
Fistula always needs surgery because it could become deeper and more complex over time and, therefore, more difficult to cure because sometimes cancer can occur on a chronic fistula.
How is fistula treated?
Fistulectomy or Fistulotomy is the surgery needed for an anal fistula. Fistula often develops four to six weeks after the drainage of an abscess and sometimes, months or years later. Surgery usually involves opening the fistula tract and excise it till the other end. Sometimes this tract is laid open and fulgurated. In complex fistulas, sometimes a Seton is required which is a thread of nylon or silk. For fistulas that involve the sphincter muscle apparatus, a flap surgery might be required to maintain the mechanism of continence. In most cases, fistula surgery can be performed on a daycare basis or with a short hospital stay.
How long does it take before the patient can resume their office?
Fistulas usually take 2 to 4 weeks to heal. Initially, pain killers are required for a few days. Usually, patients resume their work after a week.
What are the post-operative precautions and recommendations?
After the surgical treatment of an abscess or fistula, baths in warm water three or four times a day are recommended. Stool softeners (fiber, mucilage) can help prevent loose stools from traumatizing wounds. Bowel movements do not affect healing so there is no need to use contracting drugs. Even normal physical activity does not interfere with wound healing. During the healing period, a periodic check by the surgeon is important to verify the correct evolution of the wounds.
What are the chances of the recurrence of a fistula?
If it has healed properly, the problem will not usually return, though it can form in a different site. In any case, it is important to follow the surgeon’s directions to prevent a recurrence.
The anal fissure is a tear in the lining of the anal canal, almost always located in the midline mostly on the outer side. This wound tends to heal spontaneously in most of the cases. It can become chronic in some cases where it doesn’t heal. Therefore, it needs a little surgical treatment to heal, i.e. removal.
The skin that lines the anal canal has very rich sensory innervation that includes nerve corpuscles, called receptors, which are very sensitive: towards acidity or other chemical characteristics of the stool, mucus, or exudate (chemoreceptors); towards pressure (pressure sensors); towards heat (thermoreceptors).
The passage of stool causes intense pain because it stimulates the chemoreceptors, especially if the stool is acidic, and the pressure sensors, if the stool is hard. The pain can persist for many hours, because the fissure, inflamed with acid stool, induces a persistent spasm of the anus. Sometimes the pain is associated with an annoying itch due to secondary peri-anal dermatitis.
What are the causes of an anal fissure?
There are some types of fissures that result from different causes.
The fissure can be due to traditional hemorrhoidectomy surgery, which could cause tightening of the anus that is easily torn with the passage of Hard stool. Internal rectal prolapse can cause constipation due to the mechanical obstruction of the anal canal and hemorrhoidal prolapse. An excessive effort to evacuate hard stools results in more anal dilation due to the simultaneous passage of hard stools and hemorrhoids, which results in an anal tear.
Psychophysical stress and fissure – Cause and effect
There is muscle hypertonia in patients with an anxiety disorder. It can result in hypertonia of puborectalis muscle as well as perianal muscles also. This condition induces some alterations that contribute to the formation of the anal fissure. Anal hypertonicity also induces partial ischemia of the anal canal as it compresses the arteries that supply the anal canal. Also, anal hypertonicity creates ischemia by compression. The ischemic anal skin is much more fragile and therefore can “split” forming the fissure.
Treatment of Anal Fissure
A correct diagnosis of the cause causing inflammation of the anus must be made. The treatment aims to cure the cause of inflammation and/or infection of the anus.
Fissures secondary to hemorrhoidal prolapse need surgery for hemorrhoidal prolapse. It is a painless, minimally invasive technique that, through the anal orifice, removes the internal rectal prolapse using a specially created instrument. In these cases, the fissure, if chronic, is removed to promote healing.
When there is a narrowing of the anal orifice as a consequence of traditional hemorrhoid surgery, or as a consequence of chronic inflammation, the most appropriate treatment is surgical therapy. The fissure is covered with a flap from the adjacent normal skin. Anal fissure due to hypertonia of the sphincter and peri-anal muscles tends to heal spontaneously. Local treatments are of very little use, including creams based on muscle relaxants such as nifedipine, botulinum toxin, nitroglycerin, etc. In fact, the sphincter relaxation obtained with these substances is very minimal and can cause a headache. Considering that hypertonicity is of psychosomatic origin, psychiatry consultation must be taken.
Surgical treatment of anal fissure
Surgical treatment is indicated only in chronic anal fissures, i.e. after any medical treatment failure of at least 30 days. The excision of the fissure is accompanied by lateral internal sphincterotomy, where a part of the anal sphincter is divided to decrease the anal tone and promote healing.
