Curing Fistula with a laser Fiber and a scope
The art of Fistula Laser Fiber Cure
Fistula by definition is a tunnel connecting one body organ or a lumen with the surface of the skin or another organ.
What is a Fistula ?
Anal Fistula is a chronic tunnel that forms around the anus and causes repeated infection/abscess formation and discharges (spotting/soilage seen on the underwear) or itching or a pimple near the anus that wouldn’t heal, this is a serious condition that could lead to serious complications and needs to be addressed early on in its course. Do not get mixed up between anal fissure (a painful cut in anal skin) and anal fistula (a tunnel that forms and connect the anal canal with peri-anal skin).
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What causes Anal Fistula ?
Most anal fistula patients first develop a peri-anal abscess (mostly from a little infection in the mucous glands in the lining of the anal canal), these patients suddenly wake up with a red painful swelling in the skin surrounding their anus, they cannot sit comfortably, they can feel a little bump in the skin around the anal opening, it hurts if they press it, it is extremely tender, this is an anal abscess, a pocket of expanding infection filled with pus trying to explode and drain to the outside which may happen spontaneously if the patient does not go to the doctor early enough, or it may be drained by the surgeon in a more precise and proper fashion (a procedure called I & D of abscess which stands for incision and drainage of abscess.) Once the Peri-Anal Abscess is drained to the outside surgically or spontaneously, most patients feel better as the pressure of the expanding abscess tearing their peri-anal tissues disappears but in most cases the problem has not ended, they are left now with an anal fistula which is a small opening , it looks like a pimple that will never heal in the skin surrounding the anus which continues to secrete some yellowish – at times bloody -discharges… it stains the underwear or make the area wet and itchy. The anal fistula pimple may heal for a while and remains asymptomatic for few months, only to start a new abscess course once again and so on..
Is Anal Fistula a serious condition ?
Anal fistula is a condition that demands respect and prompt accurate treatment by specialized surgeon who deals with these conditions frequently, it is best done at specialized proctology center.
The main reason of the difficulties in approaching this abnormal “tunnel” and removing it or closing it is the fact that most Anal Fistula tracks pass through the rectal sphincter muscles ( these are the circular muscles surrounding the anal canal and responsible for our ano-rectal control over opening and closing our anus ) Removing Anal Fistula track or closing it without injuring the anal sphincter muscles is the main challenge that faces any surgeon approaching Anal Fistula. Injury to the external Anal Sphincter is a serious complication with long term consequences.
How do we cure Anal Fistula ? Is Surgery necessary ?
Fortunately, 85% of Anal Fistula cases are Low, i.e. below the sphincter muscle and therefore require simple laser Fistulectomy which we do it, at Laven Clinic, under simple local anesthesia in few minutes. Laser wounds heal fast, in a near painless fashion and do not interfere with patient’s daily activities at all. For those 15% of patients when we suspect that their Fistula is high (passing through significant portion of their sphincter muscle), we perform a couple of tests that help us to understand and delineate the Fistula track properly and its course through the Rectal Sphincter complex. At Laven Clinic, Our Surgeons are trained on performing Trans-Rectal UltraSound (TRUS), a few minutes simple exam that can be performed during the patient’s first visit with or without Anorectal Manometric Study ( another simple office test that measure the rectal pressures ), these tests allow us to plan the best treatment course for our patients. At times, we may order Anorectal MRI ( a radiology test that shows the pelvic anatomy and maps the course of the Fistula track ) to help us develop the best and most appropriate treatment plan.
So, how do we cure complicated ( high, through the muscles ) Anal Fistula ?
Here again, we take great advantage of our extensive experience in Endo-Laser tools to cure high fistula with a simple procedure without surgery or cutting the skin near the anus while respecting the sphincter muscle and keeping it intact at all times, we simply pass a tiny Laser Fiber through the external opening of the Anal Fistula and cauterize it closed from within, It’s called File-C Anal Fistula Track Laser Ablation, a highly elegant and very effective procedure that our Director, Dr. Sarmad Aji, FACS helped in developing and is quickly becoming the method of choice in the treatment of most anal Fistulae. We may use the Fistuloscope (a little cannula with a camera at the tip) to help us laser properly the entire Fistula track ( a procedure called Laser assisted VAAFT procedure or LA-VAAFT) when adequate, as well as more technically delicate procedures to assure the complete closure of the Fistula internal opening ( the Feeder point ) in order to achieve cure of the Fistula from the first go.
All of our Fistula treatments require less than half an hour to perform but they offer these complex Fistula patients the best and safest chance of cure with minimal or no pain and discomfort. In most cases there is no cut in the skin, no stiches and no chance of injury to the sphincter muscle. In complicated Fistula cases we use Local Anesthesia with mild sedation or less often Spinal or General anesthesia. We will explain your specific Fistula planned treatment in detail to you during your first visit.
Many patients (and Surgeons) try to ask us about the one particular treatment or procedure we use in our center for Anal Fistula, our answer is always : It is our accumulative Laser experience, our dedication to this particular field, our acquisition of the latest and best technology available anywhere in the world. There is no “One best technique“, it is often the “combination of newly refined techniques“ utilized by the Laven Clinic specialist surgeon that give the best results.