ANAL FISTULOTOMY FOR MULTIPLE ANAL FISTULAS

LASER IN FISTULA
Fistula, an abnormal connection between the internal opening in the anal canal and an external opening in the perianal skin, can be caused by various factors such as cryptoglandular infection, Crohn's disease, HIV, malignancy, and tuberculosis. The management of fistula has evolved over time, moving from sphincter-cutting procedures to sphincter-saving techniques. Accurate assessment of the fistula type, categorized by Park's classification as intersphincteric, trans-sphincteric, suprasphincteric, and extrasphincteric, is crucial for effective treatment.

Comparative studies have suggested that Fistulotomy may be preferable to Fistulectomy, although Fistulotomy is associated with late complications like recurrence and impairment of continence. Traditional Ayurvedic approaches, such as medicated setons, have been described in ancient texts. These setons, whether loose, cutting, or chemical, can impact sphincter function, leading to incontinence.

In recent times, minimally invasive procedures have gained popularity, aiming to preserve sphincter function and prevent anal incontinence. The described procedure, involves antibiotic administration, spinal anesthesia, identification of the internal opening, gentle probing, excision of the internal opening with mucosa and submucosa, Fistulotomy up to the anal verge, marsupialization, laser ablation of the distal tract, and curettage. The external opening is widened for irrigation purposes, and the patient is discharged the next day.

The discussion emphasizes the goal of minimal invasive techniques to eliminate septic foci and associated epithelialized tracts with minimal functional derangement. According to ASCRS guidelines, the principle involves obliterating the internal opening along with the epithelialized fistula tract without sphincter division. Understanding the anatomy of the anal canal is crucial for a surgeon, as nonspecific infections can lead to fistula formation.

The LASER FISTULOTOMY procedure focuses on excising the internal opening, including submucosa and mucosa, and laying open the tract from internal opening to anal verge through Fistulotomy. The use of a diode laser for tract ablation aims to enhance the procedure's efficacy.

Тэги:

#ANAL_FISTULA_tracts_of_anal_fistula #LASER #LASER_ABLATION #DIODE_LASER #APPLICATION_OF_LASER_BEAM #GOODSALL’S_RULE_LASER_SURGERY ##low_dorsal_anal_fistula ##_crypts_of_the_rectum_or_anus #FISTULA_DEVELOPMENT #DEEP_ABSCESS_CAVITY #WIDE_WOUND #CURETTAGE #FISTULOTOMY #FISTULECTOMY #LAY_OPEN #WOUND #POST_OP_PAIN #TIME_OF_OPERATION #DURATION_OF_WOUND #BLIND_ANAL_FISTULA #INCOMPLETE_FISTULA #PERIANAL_SINUS #SINGLE_OPENING_OF_ANAL_FISTULA_tracts_of_anal_fistula #GOODSALL’S_RULE

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