Pay attention to mapping in anal fistula surgery...

Perianal fistulas are known as a group of chronic and troublesome diseases. While one mouth of anal or perianal fistula is seen around the anus, the other inner mouth develops as an abnormal path in the intestine. Patients often describe a history of anal abscess. Afterwards, they may encounter persistent inflammatory discharge that does not heal. Sometimes they describe dirty laundry and itching due to discharge. It is very important to diagnose, classify and map anal fistulas correctly. For this reason, it is investigated whether there is additional pathology in patients complaining of fistula. Especially in young patients, the presence of more serious underlying diseases such as Crohn's disease in atypically located fistulas must be investigated. Fistula/abscess mapping is performed with advanced diagnostic techniques such as pelvic MRI and endoanal ultrasound (EAUS). These examinations become even more important in more complex and specific fistulas such as recurrent anal fistulas, rectovaginal and horseshoe fistulas. Especially in recurrent patients, anal pressures are evaluated in terms of possible sphincter/muscle damage that may cause incontinence. Good mapping is directly related to the success of the treatment and preventing possible complications. When a fistula develops, it is not possible to heal spontaneously or with non-surgical methods or medications. It definitely requires surgical treatment. The aim of the treatment is known as clearing and removing the gas without damaging the muscles used to hold gas and stool. For this reason, the treatment method that has the lowest risk of recurrence and does not damage the muscles is known to be the most valid. An example is given for the method called elastic cutter seton, where if you cut butter or ice cubes with a rope, the rope slowly cuts the butter or ice trays, but does not separate them into two. In this way, the path is cleared and removed without damaging the muscles. In this method, the tire falls off on its own without repeated painful squeezing operations. In addition, successful applications can be made with the laser method (FiLaC) in suitable cases. Again, the surgeon should keep Anal plug, LIFT, VAAFT, Permocol paste and loose seton methods in his repertoire, and apply them skillfully in cases where he needs to know them well...

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