Anal Fistula and Anorectal Abscess

 

Anal Fistula and Anorectal Abscess

An anal fistula is an abnormal connection between the inside of the anus and the skin around the anus. Anorectal abscesses and anal fistulas represent the acute and chronic manifestation of the same disease.
Anal fistulas are 3 to 7 times more frequent in men than in women and may rarely be found in children too.

ANAL FISTULA: CAUSES (ETIOLOGY)
Excluding anal fistulas caused be Crohn´s disease and Ulcerative colitis, most fistulas result from infection of an anal gland.
Humans have between 6 and 10 anal glands. These are found half-way up the wall of the anal canal, in the anal crypts and secrete a mucous fluid to lubricate the canal. Occasionally, bacteria present in the anus and rectum can cause an infection of one of the gland ducts, which fills up with pus and forms an abscess. The abscess drains into the perianal skin forming a kind of tunnel. This is called an anal fistula.

Symtoms

Acute phase

Pain and swelling (abscess)around the anus, fieber and feeling unwell. Pain with bowel movements, when sitting and even when coughing. The abscess may burst causing bleeding and draining pus. If the abscess does not drain by itself, it will be necessary to drain it surgically to relieve pain and infection.

Chronic phase.

It is very common for an anal fistula to form, once the acute phase is over. A fistula is an abnormal connection between the inside of the anus and the perianal skin. The sypmtoms of an anal fistula are: an openning onto the skin that may drain a seropurulent or blood-stained discharge which irritates the skin causing itching and redness. There may be pain with bowel movements and recurrent infection may lead to the formation of secondary tracts (connections), making treatment more complicated.

Diagnosis

The patient medical history tells us enought about if the patient is suffering from an anal fissure.

Exploration

Exploration which is subjected generally to patients with disease of the rectum and anus (digital rectal examination, colonoscopy, etc.) and usually tolerated without problem, PRODUCES AN INTENSIVE PAIN  IN PATIENTS WITH AN ANAL FISSURE. FOR THIS REASON WE DO NOT DO IT ON PATIENTS WITH ANAL FISSURE!

It makes no sense to get the Doctor´s fingers or sigmoidoscope (another widespread practice method) into the anus of the patient precisely because anal pain makes her life unbearable. WHAT NEEDS TO BE DONE, IS SLIGHTLY AND GENTLY SPREAD THE EDGES OF THE ANUS and then you see the crack initiation. This is not painful and confirms the diagnosis. This way we can treat the patient and then when the problem is resolved we can perform all relevant examinations.

Treatment

More surgeon reputations are lost in the treatment of anal fistula than in any other operation

The treatment of choice for anal fistula in any form is always SURGICAl.

Traditional surgery consists in canalising the fistula tract using a metal probe and cutting open the tissue above the probe. Basically, to heal the fistula it is necessary to cut through a section of the anal sphincter muscles. This form of “traditional” surgery has a high success rate in the hands of an expert surgeon, but even then, depending on the amount of muscle that needs to be cut, there is a chance that sphincter weakness (incontinence) may develop. For this reason, if a large amount of sphincter muscle needs to be cut, many surgeons choose to use a cutting Seton.

The Seton is inserted in the fistula tract and is gradually tightened in several sesion. With this method the muscle is cut progressively and not at once. The technique, described by Hipocrates and dating back to 400 BC, may be a good choice if the surgeons is unsure about the outcome of the surgery and feels there may be a large risk of developing incontinence when cutting the sphincter muscles.

Nowadays there are other treatment options that allows us to deal with complex anal fistulas, obtain better results than the conservative surgery and Seton method and not affect the function of the anal sphincter muscles.

OUR SURGICAL TECHNIQUE

Treatment of anal fistulas has two main aims:

A) To remove the anal fistula and all its tracts
B) To preserve normal anal shpincter function and integrity

At our Institute, we have been using a surgical technique called Intersphincteric Fistlulonomy with CO2 Laser since 1996. With this technique, the fistula is erradicated by closing the opennings of the tract that crosses through the sphincter muscles but without cutting through the muscles. This way, both of the objectives mentioned above are achieved: removing the fistula and preserving sphincter function and integrity. Over the years we have succesfully treated over 200 patients that presented complex fistulas, making us a leading specialist centre for the treatment of anal fistula.

 

OUR ADDRESS

Hospital Dr. Gálvez

C/ Císter, 11 (1ª planta – derecga). 29015 · Málaga.

 


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