Laser Surgery for Fistula - Procedure, Benefits, Recovery

An anal fistula is an anorectal condition where an abnormal tunnel forms, connecting the anal canal to the skin around the anus. It cannot be resolved with antibiotics. Surgical treatment is necessary to repair the anorectal tissue to remove or close the fistula channel.

Laser fistula surgery, a minimally invasive procedure for treating fistulas, involves inserting a laser fibre into the fistula from the outside and guiding it through to the opening inside the rectum. 

The laser causes the surrounding tissue to shrink. The channel is sealed with a laser. The internal opening is then closed using a suture and, in some cases, a skin flap.

Anatomy and Physiology of Anal Region

The anal region, also known as the anorectal region, is an area of the body involved in passing stool and controlling bowel movements. The anatomy of the anal region is as follows:

Anus: This is the external opening at the end of the digestive tract, where stool is expelled from the body. It is surrounded by muscles that aid in passing stool.

Anal Canal: This short passage extends from the anus to the rectum, lined with a mucous membrane. An anal fistula can occur in this region. Two types of sphincters surround it:

1. Internal Anal Sphincter: This involuntary smooth muscle remains contracted to control bowel movements and relaxes during defecation.

2. External Anal Sphincter: These voluntary muscles surround the internal sphincter.

Rectum: The last part of the large intestine temporarily stores stool before defecating.

Anal Sinuses: Small pockets in the anal canal called anal sinuses become irritated or infected, leading to conditions like anal fistulas or abscesses.

Laser surgery may be preferred when there is a need to preserve anal sphincter function. This helps in maintaining bowel continence. The indications of laser surgery treatment for fistula are:

1. Complex Fistulas: Laser surgery may be recommended for complex anal fistula, especially those with multiple tracts or branches.

2. Recurrence of Fistulas: In cases where traditional surgical approaches have resulted in fistula recurrence, laser surgery might be considered for its precision and effectiveness.

3. Inflammatory Bowel Disease (IBD) Patients: For individuals with underlying inflammatory bowel diseases like Crohn's disease, laser surgery might be considered a suitable option for fistula treatment.

Fistulas located in deep or narrow tracts may be treated with laser surgery because they can precisely reach difficult areas. Laser fistula surgery provides benefits such as:

1. Minimally Invasive: Laser surgery is often chosen for its minimally invasive nature, reducing the need for extensive incisions. This can lead to quicker recovery and less postoperative pain.

2. Quick Healing: Surgery via laser treatment minimises tissue damage compared to traditional procedures. It potentially promotes faster healing and reduces the risk of complications.

3. High Success Rates: Studies suggest that laser surgery for fistula treatment has shown promising results in terms of both short-term and long-term success rates.

Individuals often have inquiries about the process before and on the day of the laser fistula treatment. Adequate preparation beforehand ensures that the patient remains well-informed and aware of what to expect.

Protocol Before Laser Fistula Surgery

Prior to laser fistula surgery, the medical team follows guidelines. It ensures the safety of the patient throughout the process.

On the Day of Laser Fistula Surgery

On the day of laser fistula treatment, one can expect the following:

Laser fistula surgery takes around 10-15 minutes. It is a minimally invasive procedure done by a general surgeon. The patient can go home within a few hours as it is an outpatient procedure.

The laser fistula surgery procedure is as follows:

1. Patient Positioning: The positioning of the patient is determined by the location of the sinus. Whether anterior or posterior in the anus, the patient is positioned either in the prone or lithotomy position.

2. Anesthesia Administration: Regional or spinal anaesthesia is administered to induce unconsciousness. It ensures pain-free surgery.

3. Laser Probe Insertion: Following anaesthesia, the surgeon introduces a specialised laser probe into the fistula tract. With the laser probe in place, the surgeon employs focused laser energy to close and seal the fistula. This precision allows for effective treatment while minimising damage to surrounding tissues.

4. Closing Fistula Tract: The application of laser energy initiates a gradual closure and contraction of the fistula tract. This targeted approach promotes healing and reduces the likelihood of recurrence.

For a small fistula, the recovery is excellent, allowing the individual to return within a week. However, the recovery period may extend to around 15 days for deeper, complex, or higher-grade fistulas. Overall, complete healing typically takes approximately two to four weeks.

Recovery in Hospital

Patients will be closely monitored for the initial hours after surgery to ensure a smooth recovery and address any immediate concerns.

The following points outline what to expect during recovery in the hospital:

1. Monitoring Vital Signs: Regular checks of vital signs, such as heart rate and blood pressure, will be conducted to ensure the patient's stability.

2. Pain Management: Adequate pain relief measures will be provided to manage discomfort during the initial stages of recovery.

3. Wound Care: Medical professionals will guide the patient on proper wound care to minimise the risk of infection and promote healing.

4. Dietary Guidance: Clear diet and fluid intake instructions will be given to promote healing and prevent complications.

5. Encouraging Light Movement: Encouraging gentle movement and walking within the hospital room helps prevent stiffness and enhances overall recovery.

6. Post-operative Instructions: Detailed guidance on avoiding activities, hygiene practices, and follow-up appointments will be provided to support a successful recovery.

At-home Recovery

A smooth transition from hospital to home is necessary for optimal healing post-laser fistula surgery. Recovery at home includes:

1. Rest: Allow ample time for relaxation, ensuring the body has the opportunity to heal effectively.

2. Pain Management: Properly take prescribed pain medications as directed by the doctor to alleviate discomfort during the initial days at home.

3. Hygiene Practices: Follow meticulous hygiene routines, keeping the surgical area clean and dry to prevent infections. Gently wash the area with mild soap and water.

4. Dietary Considerations: Adhere to any dietary restrictions recommended by the healthcare provider, incorporating fibre-rich foods to promote regular bowel movements and aid healing.

5. Avoid Strenuous Exercise: Gradually resume light activities and avoid strenuous exercises to prevent strain on the healing area.

First Follow-up

The initial follow-up appointment is usually set for 4 to 6 days post-surgery. It ensures a smooth recovery.

The doctor will examine the surgical site. The doctor may adjust the medication depending on the healing.

Laser fistula surgery is considered safe. There may be some rare complications that can happen post-surgery. These includes:

1. Pain and Discomfort: It is common to experience pain and discomfort post-surgery. The intensity and duration vary depending on the surgery type and individual pain tolerance. Pain relief medication can help manage these symptoms.

2. Infection: Though rare, the surgical site may get infected. Keeping the surgical area clean and dry would prevent infections. Antibiotics may be prescribed for prevention or treatment.

3. Bleeding: While uncommon, post-surgery bleeding can occur. 

4. Incontinence: Although rare, incontinence is a severe complication from potential damage to the sphincter muscles controlling bowel movements during surgery. This can lead to faecal incontinence or loss of bowel control.

5. Recurrence: There's a possibility of the anal fistula reoccurring after surgery. Though the recurrence rate is relatively low, corrective surgery may be required.

When to See a Doctor?

After laser fistula surgery, it's crucial to adhere to the guidelines provided by the surgeon for a smooth recovery.

Seek medical attention if you observe any of the following post-surgery:

1. Increased anorectal pain 

2. Redness, swelling, or discharge in the anal area

3. Vomiting or nausea

4. Difficulty with digestion (no bowel movement for three days or more)

5. Fever (Chronic or higher than 102 degree C)

Delaying to address fistula can result in severe complications. This, in turn, makes the treatment more complex and raises post-surgery risks. It can heighten the likelihood of recurring and severe infections. Untreated laser fistula surgery includes:

1. Faecal Incontinence: Persistent or untreated perianal fistula may cause loss of bowel control over time.

2. Intense Pain: Pus discharge and severe pain are common symptoms when anal fistulas are left untreated.

3. Fistula Drainage and Abscess: An untreated anal fistula can lead to painful abscess formation due to ongoing drainage.

4. Peritonitis: Intestinal fistulas may trigger inflammation and infection of the peritoneum.

The laser treatment for fistula cost in India can range from ₹ 32,000 to ₹ 70,000. Several factors influence the cost of the procedure, which includes:

1. Fistula Complexity: The complexity of the fistula, whether it's simple or complex, can significantly impact the overall cost of laser surgery.

2. Hospital Facilities: The choice of hospital or medical facility, including its reputation and amenities, can contribute to variations in the total cost of the surgery.

3. Surgeon's Expertise: The experience and expertise of the surgeon performing the procedure may influence the cost. Highly skilled professionals may command higher fees.

4. Geographical Location: The location of the hospital or surgical centre can affect costs, with medical services in different regions being more or less expensive.

5. Pre-operative Tests: The need for pre-operative tests, such as imaging or blood tests, can add to the overall expenses associated with laser fistula surgery.

6. Post-operative Care: The required post-operative care and follow-up appointments can impact the total cost, including any additional medications or treatments.

7. Insurance Coverage: The extent of insurance coverage or the lack thereof plays a crucial role in determining the out-of-pocket expenses for the patient.

Laser fistula treatment has a high success rate, offering key advantages. Patients often experience less pain during and after the procedure, a major concern in surgery. 

Furthermore, the minimal or absent incontinence rates and quicker recovery contribute to heightened patient satisfaction. The precision of laser technology improves overall outcomes compared to traditional methods.

Schedule a free online consultation with HexaHealth to know more about laser fistula surgery. You can discuss your condition, including the benefits and considerations of laser surgery, with one of our top healthcare providers. 

Suggested Reads