Laser Fistula Excision (FiLaC)
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Laser excision of rectal fistula (intra-, extra-, transsphincteric, and complex) Fistula Laser Closure (FiLaC)
Rectal fistulas or pararectal fistulas are a chronic form of paraproctitis. They present as the formation of purulent tracts in the pararectal tissue surrounding the rectum, which open onto the skin in the perineal area, accompanied by bloody or bloody-purulent discharge from the skin openings, pain, itching, and skin irritation.
A rectal fistula can only be treated surgically. After an accurate diagnosis is made, preparation for surgery begins. If the doctor diagnoses an acute stage, the abscess is first opened, and fistula excision is performed after 2 weeks.
Surgical technique according to protocol, depending on the type and location of the pathological focus:
- excision of the fistula along its entire length with subsequent wound closure;
- fistula excision followed by reconstruction of the canal opening;
- application of ligatures;
- closure of the opening using biomaterials;
- sphincter muscle suturing is performed only in cases of deep damage to the sphincter muscle fibers.
The goal of any technique is to eliminate the internal (primary) fistula tract and purulent pockets while minimizing sphincter damage.
The most modern and minimally traumatic technique is Fistula Laser Closure (FiLaC) – a sphincter-preserving, minimally invasive surgical procedure aimed at eliminating the anal fistula tract. In terms of effectiveness, it is not inferior to, and in most cases surpasses, traditional techniques. This intervention is safe, minimally traumatic, and allows the patient to be effectively treated in a short time with minimal pain.
Procedure
During the operation, depending on the type and size of the fistula and the anticipated complexity of the proctologic procedure, local, spinal, or intravenous anesthesia is used. After contrasting the fistula and identifying its branches, location, and internal opening, laser ablation of the internal opening is performed with its closure. Then, using a radial laser fiber, laser treatment of the fistula tract, its branches, and the external opening is carried out. With controlled laser exposure, there is no risk of sphincter damage.
Postoperative period
The postoperative period is much easier than with traditional surgery. After the operation, the patient is prescribed antibiotics, pain relief if needed, and dynamic observation with dressing changes.
