Laser Treatment for Anal Fistula in Madanapalle

Laser treatment for anal fistula is an advanced, minimally invasive (less traumatic) procedure used to treat anal fistulas. An anal fistula is a small tunnel formed beneath the skin that connects the bowel (small and large intestines) to your anus (the opening of the rectum to the outside of the body). It most often occurs due to infections, injury, or congenital defects (present by birth). Pain in the anus, pus or blood in the stools, weight loss, and swelling in the anal area are classic symptoms of an anal fistula. Treating an anal fistula through laser is a stitch-less and painless procedure with minimal post-op complications.

Laser treatment, also known as laser ablation for anal fistula, is a safe and effective surgical technique that helps treat an anal fistula. The laser procedure is also known as FiLAC (fistula-tract laser closure), which is a sphincter muscle (circular muscles that relax or tighten to open or close the anus while bowel movements) sparing procedure. In this procedure, laser beams are targeted at the fistula's opening and generate heat energy, thereby shrinking the abnormal tissues within the tunnel. 

Lasers targeted at abnormal tissues are of different wavelengths with different tissue penetrating powers. The cells within the abnormal tissues absorb light of different wavelengths, converting the light energy to heat energy. The heat energy generated by the laser beam destroys the abnormal cells, thereby sparing the normal cells. The tissues within the anal fistula are most often ablated (destroyed) through vapourization.

An anal fistula is an abnormal tube formed between the bowel and the outer anal skin as a complication of an unhealed anal abscess. 

The anal fistula is classified into 4 grades, which include:

• Grade I- Low fistula with a single tract
• Grade II- High fistula with a single tract
• Grade III- Low fistula with multiple tracts
• Grade IV- High fistula with multiple tracts

Laser treatment for anal fistula treats or wipes out the anal fistula with minimal trauma to the surrounding tissues. This technique is usually recommended for the following reasons:

• Failure of other conventional surgical methods to treat the anal fistula.
• Anal fistulas are severely infected, causing pain and high-grade fever (>103?), with prominent blood and pus discharge in the stools.
• Due to busy schedules when you need to resume your work quickly (laser surgery provides quick recovery). 
• Grade II, III, and IV anal fistula

The type of treatment required for an anal fistula depends solely on the type and grade of the fistula. This can be determined by a proctologist (a doctor specializing in the alimentary canal's diseases, including the rectum, colon, and anus) through careful evaluation of your symptoms, medical history, physical examination, and diagnostic tests (both medical and imaging). 

Medical history

Your doctor will discuss your medical history to get an understanding of your general health Your doctor will also need information about:

• Any other medical condition like diabetes (increased blood sugar levels), hypertension (high blood pressure), or other diseases related to the heart, lungs or kidneys that you may have.
• History of any previous injury or surgery that could be a risk factor for developing an anal fistula.
• History of fecal incontinence (inability to control or hold back the stools) or chronic (long-lasting) constipation.
• Medications you are currently taking like blood thinners, anti-inflammatory and anti-hypertensive drugs, antidepressants, or other herbal and vitamin supplements.
• Social habits like smoking and alcoholism as they may hinder your recovery process. 

Physical/Clinical examination

• Your doctor will clinically examine your anal area to correlate with your symptoms.
• Digital examination using gloved and lubricated fingers is conducted to check for the following:
  • Presence of the fistula
  • Tenderness around the area
  • Presence of any swelling or lump
  • Bleeding from the anal area during insertion of the finger

Diagnostic tests

• Urine test: A urine sample will be taken to check for urinary tract infections.
• Complete blood count (CBC): A blood sample will be taken to measure several blood components like red blood cells, white blood cells, etc., to detect the presence of any infection.
• Anoscopy: It is an examination of the anal canal using a special scope to detect the presence of a fistula.
• X-ray scan: This is used to evaluate the damage caused due to the fistula at the infection through X-ray images.
• MRI (Magnetic Resonance Imaging): An imaging test that uses a magnetic field to capture images of the organs affected to confirm the presence of a fistula.
• Endoscopy: A thin, flexible tube called an endoscope (consisting of a light source and camera) will be inserted to detect the presence of a fistula within organs or cavities. Helps detect gastrointestinal fistulas.
• Fistulogram: A particular type of X-ray that uses a dye that will be injected into the fistula to provide detailed imaging.

Pre-procedure preparation

Based on the clinical examination and the diagnostic tests, your proctologist will determine the type of surgery required for an anal fistula. If you are considered a suitable candidate for a laser fistula treatment, your doctor will give you the following instructions to prepare you for the surgery. This will remove all the stress and anxiety associated with a surgical procedure for smooth surgery and recovery. Your doctor will advise you to:

• Discontinue medications (blood thinners, etc.) at least 2 to 3 weeks before the laser treatment.
• Avoid smoking and alcohol 2 weeks before the procedure.
• Take time off from work in advance for at least 4 to 5 days after the surgery.
• Fast for 8 to 12 hours before the laser surgery since the procedure is performed under general anesthesia (a numbing agent that puts you to sleep) to prevent the aspiration of food particles into the windpipe.
• Arrange for someone to drive you back home since you may experience dizziness after the effect of anesthesia wears off.

Laser treatment for an anal fistula is a minimally invasive procedure performed at the daycare unit under general anesthesia. Once your proctologist (a doctor specializing in the diseases of the colon, rectum, and anus) considers you suitable for laser surgery, you will be prepped for the procedure accordingly.

Preparation

• You will be taken to a laser-equipped room for the procedure.
• Your nurse will shave any excess hair around the surgical site (if present). 
• The anal area will be disinfected using an antiseptic solution such as betadine to remove surface contaminants that may cause infection. 
• An IV (intravenous) line will be introduced through a thin needle to administer anesthesia, fluids, and antibiotics.
• Your surgeon will mark the area around the anus where the laser probe will be inserted.

Anesthesia

• The anesthesiologist will administer general anesthesia (GA) through IV infusion. 
• Throughout the procedure, your vitals (blood pressure, heart rate, pulse, and oxygen levels) will be continuously monitored. 

Procedure

• Your surgeon will adjust the wavelength of the laser used. 
• A flexible, round, laser-radiating fiber-optic probe will be inserted into the fistula tract from the outside.
• The laser light from the probe gets absorbed by the abnormal tissue lining of the anal fistula that gets converted to heat energy.
• This vaporizes (electrocauterizes) the tissue lining and shrinks the cells within the anal fistula.

Wound closure

• The fistula lining shrinks, and the fistula contracts, sealing the external opening.
• Your surgeon will pack the surgical site with a medicated dressing that will be removed before you are sent home. 
• The laser procedure will usually take around 15 to 30 minutes.

Once the procedure is completed, you will likely spend 2 to 3 hours in a recovery room until your vitals are stabilized. 

In the hospital

• You may take a few hours to regain consciousness and move around. 
• You may experience mild pain, soreness, and discomfort when the effect of anesthesia begins to wear off slowly. 
• You will be given only sips of water until you are in the recovery room. 
• Once you can get up and walk a few steps, your surgeon will begin fluids like juices, etc. 
• By the end of the day (5 to 6 hours after the procedure), you will be allowed to go home.
• Your surgical pack or dressing will be removed before you are sent home.
• Your doctor will prescribe painkillers, laxatives, and antibiotics to ease pain and strained bowel movements and prevent post-op infections.

At home 

• Resting once you return home is advisable so your body gets adequate time to heal. 
• Move around as much as possible to prevent blood clot formation.
• You must take a Sitz bath (sitting on a tub of plain warm water) for 15 to 20 minutes, 3 to 4 times daily. 
• You must consume a healthy, fiber-rich diet to prevent constipation. Avoid spicy foods (chilies, pepper), high-fat dairy products (cheese, butter, etc.), and junk food (pizzas, burgers, fries, etc.) for at least 2 to 3 weeks. 
• Hydrate yourself well by drinking at least 1 to 2 liters of fluid (water, juice, soups, etc). 
• Use laxatives (stool softeners) prescribed by your surgeon for easy bowel movements.
• Avoid lifting heavy objects and strenuous exercises and activities for a period of 3 weeks.
• You may resume work and other daily activities as early as 5 to 7 days post-laser surgery.
• Complete recovery may take around 2 weeks post-laser treatment.

Laser surgery for an anal fistula is a popular treatment method that is widely used due to the following benefits:

Benefits

• Does not involve extensive incisions (cuts) like the conventional open fistula surgery
• A stitch-less procedure
• Painless surgery since there are no incisions involved
• Quick healing time with a speedy recovery
• Minimal or no trauma to the surrounding tissues
• Minimal bleeding during and after the surgery
• Low risk of damage to the sphincter muscles

Risks 

As with any surgical procedure, a few risks are involved in the laser treatment. However, the risks are minimal when compared to conventional open fistula surgery.

• Allergic reactions to anesthesia with prominent skin rash, itching, facial edema (swelling), redness, nausea, confusion, dizziness, and shortness of breath.
• Secondary infection around the surgical wound with/without pus discharge.
• Mild bruising around the anal region.

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