Anal fistulas are abnormal passages that form between the anus or rectum and the skin around the anus. They are often caused by an infection in the anal gland, which can lead to the formation of an abscess. If left untreated, the abscess can rupture and form a fistula.
Depending on the severity and complexity of the fistula, several surgical and non-invasive treatment options are available in Turkey.
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- Anal incontinence
- Risk of recurrence
- Oozing at the scar
- It all depends on the surgical technique adopted
Perianal Abscesses and Anal Fistulas: What are they?
An anal abscess is an accumulation of pus near the anus and rectum and is almost always the result of an infection of a small anal gland that exits into the anal canal.
The anal fistula, which often results from an anal microabscess, is a tunnel of varying length (from a few millimeters to several centimeters) that connects the anal outlet of the infected gland to an external hole from which blood, purulent and/or fecal material may ooze. This small hole often occurs at or near the site of a perianal abscess after its spontaneous or surgical opening.
Abscess and fistula are therefore two aspects (acute and chronic) of the same disease, which are usually treated at different times.
There are different types of fistulas (classified according to their complexity):
- Subsphincteric fistula
- Intersphincter fistula
- Trans-sphincter fistula
- Supra-sphincter fistula
- Extra-sphincter fistula
Depending on the type of fistula and the way it presents, the prognosis for treatment and recovery will be different.
Diagnosis of Perianal Fistula in Turkey
The diagnosis of abscess and perianal fistula is mainly clinical. It is obtained by ambulatory proctological examination and anoscopy.
Sometimes it is necessary to identify possible complex fistulous tracts by performing transanal ultrasound with a 360° rotating probe.
This examination can also help identify unrecognized microabscesses and any unrecognized sphincter lesions.
Magnetic resonance imaging is another equally accurate examination, usually reserved for the most complex cases.
Treatment of Perianal Abscess in Turkey
A surgical incision is made in the skin over the abscess to drain the pus from the infected area to the outside and alleviate pressure in the abscess cavity.
This procedure can be done under local anesthesia. In some cases, hospitalization and surgery under involuntary heavy sedation may be required for a large or deep abscess.
People at higher risk of infection, such as diabetics or those with weakened immune systems, may also need to be hospitalized. The use of antibiotics is an alternative to surgical drainage of pus, but they often have limited effectiveness and may only be useful for small (2 cm) infections.
Anal Fistula Surgery
Surgery is necessary to repair an anal fistula. For submucosal fistulas and those involving a small portion of the sphincter, the surgery consists of
A fistulotomy is an incision and opening of the fistulous passage with "second-line" surgical wound healing, i.e. without sutures. The wound heals from the inside out and is treated with bandages.
The cutting Seton technique
Cutting Seton is a surgical technique used to treat fistulas that involve a large portion of the anal sphincter, known as trans-sphincter fistulas.
The Seton is a surgical wire made of absorbable or non-absorbable material that is surgically placed into the fistula after careful identification of the fistula.
It may be either:
- A tight seton that is tightened at intervals during outpatient visits to slowly dissect the anal sphincter, allowing gradual healing of the fistula without compromising the sphincter system.
- A simple seton may also be placed for drainage for 4–6 weeks to allow for a second surgical procedure.
Removal of the fistula tract (Fistulectomy)
Fistulectomy is surgery to remove the entire fistula tract. The sphincter incision is repaired and the muscle plasty is restored (from the inside of the anal canal) with a rectal advancement flap that is lowered to cover the surgical site and the previous fistula opening.
The anal PLUG technique
This is a relatively new surgical technique in which a small rod of biocompatible material is inserted into and along the length of the fistula to close the abnormal tract and promote healing. This technique does not require any kind of incision or cutting of tissue and/or muscle. In a procedure similar to the previous one, fibrin glue (derived from clotting substances found in human serum) is injected into the fistula path.
The PLUG technique is often used to treat complex anal fistulas that have a high risk of recurrence after traditional surgery.
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