Balance between radicality and function
A transsphincteric fistula passes through the sphincter muscle, and the surgeon solves a double problem: to remove the passage completely, but to cross a minimum of muscle fibers. If the passage passes through the superficial portion, it is excised simultaneously with suturing of the muscle. When deep portions are involved, sphincter-preserving techniques are used - ligature technique or displaced flap. The complexity of the operation and healing time depend on the level of passage through the sphincter.
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.