A separate pathology not related to the intestine
The epithelial-coccygeal duct is a congenital canal lined with skin epithelium with hair follicles, located in the intergluteal fold. It does not communicate with the rectum, so it is an independent disease and not a type of perirectal fistula. The passage periodically suppurates, and after each opening new fistula openings remain. Radical treatment is excision of the entire course with branches in a single block to the sacral fascia. The method of wound closure determines the healing time: tightly sutured provides a faster recovery, open management - a lower risk of relapse.
What is a perirectal fistula?
A fistula is a pathological canal connecting the rectal cavity to the skin of the perineum. In most cases, it is formed as a result of acute paraproctitis: the abscess has opened, the pus has come out, but the canal remains and periodically becomes inflamed again.
The fistula does not heal on its own: its walls are lined with epithelium and scar tissue. Conservative treatment can only temporarily reduce inflammation, so the only radical method is surgery.
Why are fistulas divided in relation to the sphincter?
- intrasphincteric - passes inside the internal sphincter, the easiest to treat
- transsphincteric - crosses part of the sphincter fibers
- extrasphincteric - bypasses the sphincter from the outside, the most complex, has degrees of complexity I–IV
- epithelial-coccygeal - a separate pathology of the sacrococcygeal region, not associated with the rectum
The main risk of the operation
The key task of the surgeon is to remove the fistula completely and at the same time preserve the function of the anal sphincter. The more sphincter fibers are involved in the fistulous tract, the more complex the operation and the higher the requirements for technology. That is why the volume of intervention and its cost directly depend on the type of fistula.