Perianal fistula surgery - classic
Spontaneous healing of fistulas is extremely rare and surgical treatment is always indicated. With surgical methods of treatment, there is always a risk of sphincter lesions and possible continental disorders. Due to the high recurrence rate, none of the surgical methods is the gold standard in the treatment of perianal fistulas and none can guarantee a complete cure for the patient. Surgical treatment options for fistulas are fistulotomies, flap procedures, and more recently fistula plug procedures (small cylinders of porcine collagen that are placed in the fistulous canal), the LIFT technique where the fistulous canal is shown, then the inner and outer opening is ligated, and the canal itself is excised. Establishing long-term seton drainage in combination with biological therapy leads to the healing of fistulas in inflammatory bowel disease.
It should be noted that the success of the treatment of this complex disease is about 60%, and in a certain number of patients, unfortunately, recurrence of the disease can be expected in a certain period.
Description of the procedure
After proctological examination, when the existence of a fistula is determined, it is necessary to determine the course of the fistulous canal and its relation to important anatomical structures (sphincters) by certain imaging methods (ultrasound or MR). Preoperatively, most patients need to have a seton drain to further squeeze the contents of the fistula out of the area, which is kept for several weeks. After that, the procedure is performed under short-term general or spinal anesthesia - the patient was previously examined by an anesthesiologist and filled out an appropriate health status questionnaire.
During the procedure, the previously placed seton is removed, and then laser energy is applied to the fistulous canal. It is necessary to close the inner opening of the fistula with one suture.
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In the postoperative period, there is a certain secretion on the outer opening of the fistula (due to necrotic tissue caused by laser energy), which gradually decreases over several weeks, in parallel with the healing process of the fistula.