Laser Fistula Treatment in Kukatpally, Hyderabad
Commonly called as piles in telugu ( Molalu , Malalavyadi / Moola Shanka )
The anal canal typically has numerous glands that secretes fluid. When bacteria enters these glands, an infection may be caused, leading to an abscess. Looking for an area to drain itself, the abscess punctures a hole in the skin near the anus, to release the built-up infected fluid, creating an anal fistula. While most anal fistulas are caused by an infection, in rare circumstances, they could be a result of chronic conditions in the body.
Causes
- Crohn’s disease(Inflammatory disease of intestine)
- Radiation(Treatment for cancer)
- Tuberculosis
- Sexually transmitted diseases
- Diverticulitis(A disease in which small pouches form in the large intestines and become inflamed)
Symptoms
- Pain in rectum
- Anal bleeding
- Swelling and itching around the anus
- Pain while defecation(Passing stools)
- Fever
- A foul smelling fluid oozing from a hole near the anus
Diagnosis
- Colonoscopy
- Anoscopy
- Proctoscopy
- Sigmoidoscopy
Treatment for Fistula
- VAAFT (Video Assisted Anal Fistula Treatment)
- FILAC (Fistula Laser Closure)
- SLOFT (Sub-mucosal Ligation Of Fistula Tract Closure)
- Endo-Rectal Advancement Flap Surgery
- LIFT (Ligation of Intersphincteric Fistula Tract Closure)
1. VAAFT Treatment
It is safe and well tolerated. This procedure is done in two phases. (Diagnostic and Operative). Before the procedure, the patient is given Spinal or General anaesthesia and is placed in lithotomy position.
a) In the diagnostic phase, the fistuloscopy is inserted into the fistula to locate the internal opening in the anus and to identify any secondary tracts or pus cavities. The anal canal is irrigated to get a clear view of fistula tract. Light from the fistuloscope can be seen from inside the anal canal at the location of the internal opening of the fistula, which helps to locate the internal opening.
Advantages
- Allows the surgeon to see inside the anal fistula tract and locate the internal opening using an endoscopic light
- It preserves the sphincter muscles function and faecal continence
- Safe and Painless
- Feasible, day care procedure
- High success rates and fastest recovery period
- Minimal invasive
Complications
- Incontinence
- Bleeding
- Urinary retention
- Constipation
2. FILAC Treatment
In this laser therapy, a laser probe is introduced into the fistula tract. The fistula tissue is destroyed with the laser in the gentlest way and then the laser probe is slowly pulled back and the fistula is being closed. The extremely flexible probe is suitable for the application even in wound tracts.
Advantages
- Time sparing
- Doesn’t affect the healthy tissue
- Painless
- Shorter recovery period
3. SLOFT Treatment
It is an upgraded version of LIFT procedure. In this procedure, the external opening is cannulated and the internal opening is defined with the help of Normal Saline and Hydrogen Peroxide. A pliable probe is inserted along the tract and taken out of anus. A small incision is made on the skin over the probe in the fistula tract and the tract is hooked from the below of the probe. The distal tract is cored/ cauterised, leaving the sub-mucosal space open. Most of the fistulae are healed in 30-40days.
Advantages
- Discharged in 1day
- No post-operative discharge dressing necessary
- Easy. Operating time is 30minutes
- Faster recovery than LIFT
- Can resume activities of daily living in 2-3 days
4. SEndo-Rectal Advancement Flap Surgery
In this surgery, the internal opening of the fistula is identified and a flap of mucosal tissue is cut around the opening. The flap is lifted to expose the fistula, coring out the infected part, which is then cleaned and the internal opening is sewn shut with a cutaneous flap providing effective drainage.
Advantages
- Discharged in 1day
- No post-operative discharge dressing necessary
- Easy. Operating time is 30minutes
- Faster recovery than LIFT
- Can resume activities of daily living in 2-3 days
5. LIFT
In this procedure, the inter-sphincteric tract is identified with the help of a probe and a small incision is made overlying the probe, connecting the external and internal opening. The tract is isolated by performing meticulous dissection through the inter-sphincteric plane. The fistula tract is removed, ligated close to the internal sphincter and then divided distal to the point of ligation. Suture closure of external sphincter muscle and inter-sphincteric wound is performed.
Advantages
- Simple/ Safe
- High healing rate with no risk of incontinence
- Faster recovery time
- Lower early post-operative pain score
Post-Operative Care
The dressings have to be done everyday
Patient’s are advised to Maintain smooth bowel movements, clean the anus with warm salt water after defecation and Avoid anal contractions, sitz bath, strenuous activity, sexual activity, exercise and lifting weights for the first 2 weeks post operatively.
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FAQ's
What causes a fistula?
After an abscess has been drained, a passage may remain between the anal gland and the skin, resulting in a fistula. If the gland does not heal, there will be persistent drainage through this passage. If the outside opening of the fistula heals first, a recurrent abscess may develop.
How is a fistula treated?
Surgery is generally necessary to treat a perianal fistula. This usually involves cutting a small portion of the anal sphincter muscle to open the passage, joining the external and internal opening, and converting the passage into a groove that will then heal from the inside out. Most fistula surgeries can be performed on an outpatient basis. If the fistula involves too much sphincter muscle, a two-stage procedure or more complicated repair may be necessary.
How is an anal fistula diagnosed?
Your doctor can usually diagnose an anal fistula by examining the area around the anus. He or she will look for an opening (the fistula tract) on the skin. The doctor will then try to determine how deep the tract is, and the direction in which it is going. In many cases, there will be drainage from the external opening.
Is any follow-up treatment necessary for an anal fistula?
Most fistulas respond well to surgery. After the surgery, your surgeon may recommend that you soak the affected area in a warm bath, known as a sitz bath, and that you take stool softeners or laxatives for a week.