Usually, diagnosis can be made by history and specialist doctor's examination. In some cases, a pelvic MRI may be required.
THE ONLY TREATMENT OPTION FOR PERIANAL FISTULA IS SURGERY. THERE IS NO MEDICAL TREATMENT.!!!!
The ideal surgical treatment for anal fistula should eliminate the infection and stimulate wound healing in the fistula tract.
The type of surgery varies depending on the location of the anal fistula.
Fistulotomy/Fistulectomy
If the fistula tract is superficial or the fistula tract does not pass through important muscles, the fistula tract is cut and opened and open wound healing is expected. This is called fistulotomy. The fistula tract can be removed in some cases. This is called fistulectomy.
The situation is different in the presence of a fistula path passing through important muscles, that is, in complicated fistulas. It is important to treat the muscles without damaging them. For this purpose, many methods with varying effectiveness have been identified in the last twenty years.
SETON METHOD
If the fistula path contains muscles that will cause gas and fecal incontinence if cut, that is, if it passes through these muscles, it is It becomes very important to perform the surgery without cutting these muscles. It uses the seton method to prevent damage to important muscles. In the Seton technique, a thread is passed through the fistula duct, which will stimulate wound healing and allow the fistula tract to close. This rope remains in the body for weeks and repairs the muscles while slowly cutting them. In this way, gas and fecal incontinence that may occur as a result of sudden muscle cutting is prevented. Wound healing after surgery should be closely monitored. During wound healing, situations such as some wound healing disorders, abscess formation, embedding of the placed seton into the body, etc. may occur. In these cases, minor interventions may be required again.
Since Seton remains in the body for a long time, it is normal to have discharge as it creates a foreign body reaction in this area as long as it remains. This reaction is a desired condition that ensures healing of the fistula tract.
This method has been used for a long time. It can also be used in combination by placing a seton on the part containing important muscles after cutting a part of the fistula path (fistulotomy).
LASER METHOD
Laser has begun to be used in fistula treatment in recent years. Treat fistula with laser But in this method, the fistula tract is first curetted and cleaned. Then, a catheter with a laser beam is inserted into the fistula tract and the fistula tract is closed with a laser.
In this method, no open wound occurs for months.
The patient is discharged on the same day after the procedure.
This method does not damage the sphincters, thus eliminating the risk of gas and fecal incontinence, which are the most feared complications of this type of surgery.
It is not preferred in the presence of an abscess.
OTHER METHODS. ;
LIFT (Intersphincteric fistula tract ligation); In this method, the fistula path is found between the muscles, both sides are tied and cut. The part that opens to the skin is curetted.
Anal fistula plug is another method. A material made from pig small intestine mucosa is placed into the fistula tract and the fistula tract is closed. In the fibrin glue method, the fistula tract is filled and closed with a type of tissue glue.
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