A fistula is an abnormal communication between an organ, a blood vessel or intestine and another structure. Generally, fistulas are the result of trauma or surgery, but can also result from infection or inflammation of the organ affected.
Perianal fistula is in most cases of inflammation of the region surrounding the anus produces an annoying and painful swelling with a secretion of pus or fecal material (including material can present bloody) that causes various symptoms such as itching , eczema of the skin and usually the surrounding stained underwear. Occasionally may cause general symptoms such as fever and so on.
In most cases, the origin of the fistula is perianal abscess that could have been drained by surgical methods or did it spontaneously leaving sequelae such as fibrous communication which produces the annoying secretion. At other times the origin of the fistula is linked to various anorectal disorders that occur with chronic constipation or diarrhea a motivating device dysfunction sphincter (the valve that performs the function of continence and fecal material). Diseases like regional enteritis or Crohn's disease, hemorrhoids, etc.., May be associated with perianal fistula. Other times, it is instrumental exploration of an illness or disease in the abdomen like appendicitis, or infection in the tubes or that complicated colonic diverticula, which cause these fistulae.
The diagnosis in most cases is simple and the patient referred that motivates suppuration constant symptoms such as itching and stain on the underwear. By exploring the conduit must identify and establish the route of the fistula. Based on that tour we classify fistulas in high or low, "intra", "inter" or "extra" depending on their position with respect to the external sphincter, or subcutaneous, etc..
This fact is very important as it will be decisive in choosing the type of technique used. If you are an imaginary line that divides the anal orifice in two halves, before (in relation to the scrotum) and later (in relation to the sacrum bone), the fistulae were established in the anterior portion usually have an "straight" however, the higher has a tortuous and uncertain route.
The treatment is surgery, and these processes have been used for different techniques that will depend on the clinical characteristics of the fistula. Seeking to remove the fistulous path and leave a level (not close) to be healing slowly. The realization of it, ie its technical execution, has many variants. Some have done with the cold scalpel (conventional) and hemostasis (coagulation of getting vessels to blood) is carried out by ligation of the vessels or the electric scalpel. The form of execution used by most surgeons is to use the scalpel to perform both electrical fistulectomy (removal of the fistulous tract) and for hemostasis. The laser scalpel gets to do the above mentioned but with the improvement of the technical accuracy and more selective coagulation.
Published articles referring to these techniques in the best laser scalpel, but there were no significant differences in the results obtained with other methods. This means that the knife used in principle does not influence the rate of recurrence. It should be noted that the recurrence of the fistula after surgical treatment of it is nothing unusual. Sometimes this is associated with relapse in patients with Crohn's disease or other diseases that create a basis for further reproduction of the fistula, the occurrence of fistulas atypical in number and location to their surgical treatment difficult and very complex. In other cases the relapse was caused by problems in the surgical field to remove the whole fistulous or crypt abscess or producing them due to travel (usually the later more complex) or the location of it.
In any case, the surgical treatment of relapsed fistulas carries an increased risk of anorectal damage structures, and needs to be done with extreme care, as your surgeon will explain.
The successful outcome in the treatment of relapsed fistula is not the type of knife that is used but the surgical findings, disposition of the field, type of fistula and associated diseases and the potential for resection of the same.
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