Perianal fistulae are a common septic condition of the perianal region.
Symptoms:
• Seropurulent discharge (particularly when an abscess has drained spontaneously)
• Perianal pain
• Erythema and swelling in the perianal area
• Fever, often high and persistent, especially when the tract does not drain externally
Perianal fistulae may coexist with inflammatory bowel diseases such as Crohn’s disease.
Their aetiology is largely unknown. In many cases, fistula formation follows the drainage of a perianal abscess.
Treatment / Management: Surgical only, but in this case with the use of laser fibres.
Under general anaesthesia (preferred), the following steps are undertaken:
a. Identification of the internal and external openings of the fistulous tract
b. Identification of the course of the tract using surgical instruments
c. Instead of lay-open and drainage, the fistulous tract is obliterated from the external opening using laser fibres. No large wound is created.
Particular attention must be given to accurately determining the relationship between the fistulous tract and the anal sphincter complex / pelvic floor muscles.
Only in this way can sphincter injury and subsequent faecal incontinence be avoided.
With this technique, the sphincters are not affected because no surgical division occurs.
Accurate and properly executed laser ablation and drainage of the fistulous tract results in good and rapid healing.
Evaluation for perianal fistulae is best performed subsequently, once an MRI of the region has been obtained.
