Alternative to classical excision
Classic surgery for the coccygeal tract involves excision of the entire mass of tissue in a single block to the sacral fascia. The wound turns out to be extensive, and healing in the intergluteal fold - an area of constant friction and moisture - takes from a month to several, often with sutures coming apart. The laser technique is fundamentally different: a light guide is inserted through the existing holes, the epithelial lining of the tract and its branches is destroyed, and the channel collapses. There is virtually no incision, and the patient returns to work within a few days. Limitation - with extensive branched passages with multiple openings and after several suppurations, the effectiveness is lower than that of radical excision.
Why does the fistula not heal on its own?
Pararectal fistula is a pathological channel between the lumen of the rectum and the skin of the perineum. Most often, it is formed as a result of acute paraproctitis: the abscess has opened, the pus has come out, but the tract lined with epithelium remains.
The walls of the fistula do not grow together, so antibiotics and ointments provide only a temporary lull - the process periodically worsens. The only radical treatment method is surgical.
Classification in relation to the sphincter
- intrasphincteric - inside the internal sphincter, the simplest
- transsphincteric - crosses part of the sphincter fibers
- extrasphincteric - bypasses the sphincter from the outside, the most complex
- incomplete internal - opens only into the intestinal lumen
- epithelial-coccygeal tract - a separate pathology of the sacrococcygeal region
Classic surgery or laser
With classic intervention, the fistula tract is excised with a scalpel along with scar tissue - the method is as radical as possible, but requires caution when the sphincter is involved. Laser destruction works differently: a thin light guide is introduced and processed from the inside, the walls coagulate and collapse. The sphincter muscle is not crossed, so the risk of loss of control is minimal, and healing is faster. The choice of method is determined by the type of fistula, the presence of leaks and previous operations.