High fistula in ano, treatments with CO2 laser, challenges, in Thi – Qar governorate

Abstract

Background: High Fistula-in-ano is a common surgical problem, it is regarded a challenge to the surgeonsdue tocarry a high risk of recurrence and complications especially of anal incontinence, theaim of the surgical procedure is to altogether remove the fistula, prevent recurrence and avoiding the main complications like anal incontinence. The need to reduce the anal sphincter damage lead to the use of fibrin glue, collagen plug, clip closure, mucosal flap advancement techniques, ligation of intersphincteric fistula tract (LIFT), Video-assisted anal fistula treatment (VAAFT) and Fistula laser closure (FiLaCTM). Carbon dioxide (CO2) laser used as a tool in the treatment of anal fistula. The CO2 10600nm laser allowing increased surgical precision and accuracy, thin depth (0.03mm) penetration, thereby reducing unnecessary damage to underlying tissues, and the procedure was with no bleeding, resulting in improving visualization of the surgical field, eliminating the need for electro-cautery which can cause more damage, also closed the lymphatic and nerve endings reduce the oedema and pain. The aim of this study is to evaluate the benefit of CO2 laser to remove anal fistula. Methods: 26patients between 23 to 45year old with a mean age of 32-year-old (SD±6.4) with high fistula in ano measured 7.5 to 10 cm, mean 8.41(SD±0.85), all were direct fistula except one was complicated & only one was a recurrent fistula. Operation (fistuloctomy) was done under spinal anaesthesia, Result: On following all patients, the pain was moderate in fourpatients, no primary bleeding, no recurrence or faecal incontinence; all patients started their Routine work in about fivedays. Conclusion: The CO2 laser may a good tool for anal fistula excision because of almost bloodless surgery, reduce the risk of infection and precisely controlled surgery which limits injury to surrounding tissue.