Anal fistula – laser removal

An anal fistula is an abnormal connection between the anal canal and the perianal skin, which does not heal on its own.

If the sphincters are affected, it may lead to their weakening, resulting in flatulence or faecal incontinence. For this reason, anal fistula is considered a chronic condition that requires long-term treatment under the care of a proctologist.

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Symptoms of anal fistula

The characteristic symptom of anal fistula is an internal opening, usually in the area of the inflamed Hermann’s anal gland in the anal canal, and an external opening, usually in the skin in the rectal area. The opening in the anal area is usually noticeable. In addition, it may ooze pus. Due to the location of the internal opening, pus may also leak out of the anal canal.

Other typical symptoms include itching and burning sensation in the anal area, as well as flatulence and faecal continence problems. Burning pain, a feeling of heat in the anal area or fever require urgent medical attention, as they may suggest an overgrowth of the internal and external fistula opening and the formation of an anal abscess. Recurrent anal abscesses may also indicate fistula formation.

Causes of anal fistula

Anal fistula may form as a result of a bacterial infection of the glands in the anal canal (anal abscess). It may develop as a direct consequence of an abscess, or may form in a scar where incision was made to treat purulent lesion.

Other disorders that can lead to a fistula include ulcerative colitis, Crohn’s disease, inflammation of the sweat glands of the skin in the anal area, surgeries carried out on the anal area, anal trauma or a foreign body, a hair cyst between the buttocks, perianal complications, weakened immune system, cancer and related radiotherapy.

Treatment of anal fistula

Anal fistula is always treated surgically. The method depends on the location of the channel in relation to the anal sphincter muscles and should be adapted to a given case to lower the risk of flatulence or faecal incontinence as a result of the procedure.

One of the state-of-the-art methods of fistula treatment is the FiLaC (Fistula-Tract Laser Closure) technique. It involves insertion of a narrow radial fibre optic tube from the outside, which emits laser energy with a wavelength of 1470 nm towards the fistula walls, damaging the fistula tissue and causing it to collapse. The aim of the procedure is to gently remove the fistula, without risking damage to the sphincter, taking care to preserve muscle structures as much as possible and minimise the risk of post-surgery flatulence and faecal incontinence.

The procedure is performed with the Leonardo Dual Biolitec laser with a narrow radial fibre optic and a spherical shape of the tip, which speeds up the healing process. It also ensures a homogeneous photothermal distribution along the entire length of the fistula, causing its full closure. In addition, the laser energy restores the natural anatomical structure without affecting the muscles, the lining of the anal canal and the mucosa. The procedure is performed under anaesthesia, the type of which is determined during consultation with the anaesthesiologist. Usually, spinal anaesthesia is used.

Surprisingly, anal fistula is a common ailment that usually affects middle-aged men. It is also sometimes diagnosed in children in a congenital form. Unfortunately, there are no effective preventive measures. The treatment of anal fistula is complicated and time-consuming. If neglected, it poses a risk of a significant deterioration in the patient’s comfort of life. The progressing inflammation may even lead to sepsis.

Source: Harvard Medical School

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