The most difficult option
An extrasphincteric fistula goes around the entire sphincteric apparatus and opens into the rectum high above it, often having branched passages and purulent leaks. Classic excision here requires staged treatment with a ligature, which is gradually tightened over weeks - a long and painful process. Laser destruction allows you to treat an extended course in one intervention without crossing the muscles. However, with a wide range of leaks, laser alone is not enough: the technique is combined with drainage of the leaks and suturing of the internal hole, and sometimes re-treatment is required.
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.