Fistula-in-ano is a common perianal condition that is associated with appreciable morbidity and inconvenience to the patient. The morbidity increases with the more complex or high type of fistulae. The most notable classification of fistula type is by Park's and this is based on the relationship between the fistula track and the anal sphincters (1). However, the complexity and the relevance of this classification raise doubts of its use in the routine management of anal fistula.
The principles of anal fistula surgery are to eliminate the fistula, prevent recurrence and preserve sphincter function. Success is usually determined by identification of the primary opening and dividing the least amount of sphincteric muscle possible. Most of the anal fistulae have been conventionally treated by either fistulotomy or fistulectomy, which have proven to be effective (2). However, the procedure requires local, regional or general anaesthesia.
Post-operative wounds are usually left open and take much time to be completely healed through secondary intention. Furthermore, there exists a noticeable risk of recurrence and incontinence especially in high risk patients with complex or high fistulas, women with anterior fistulas and elderly patients (2). Setons have been used to manage anal fistula for hundreds of years. In the literature, setons were commonly described only for the high or complex anal fistula in order to avoid faecal incontinence and recurrence.
The usage of this method was deemed cumbersome and too slow.In this study, we have described the initial results of the routine use of the two setons placement method, comprising one drainage seton and another primary cutting seton, for all consecutive patients with any type of anal fistulae in the outpatient clinic.
sclerotherapy: Injection therapy or sclerotherapy is one of the oldest forms of therapy. It involves giving injections of certain solutions at the base of the hemorrhoids. The solution that is infected causes scarring & prevents further prolapse of the hemorrhoid. This procedure is an out door patient procedure & is performed without anesthesia.
A viewing instrument (Anoscope) is inserted in to the anus; the hemorrhoid is located a solution is injected around the base of the hemorrhoids. Laser surgery: Lasers are strong enough to cut through diamonds, yet they can be gentle enough to sculpt the delicate surface of your eye. In the medical world, these scalpels of light are helpful in many procedures.
But as high-tech as these magic wands are, they can't zap away every problem. They may be the right tool for some surgeries but not the best choice for others. "I think many people believe laser surgery is new technology and therefore better," says Maurice Webb, M.D., a specialist in gynecological surgery at Mayo Clinic, Rochester , Minn.
"But it's not necessarily better under all circumstances. Just as you use a specific medication for a specific purpose, you use a laser for a specific purpose." In addition, as with any operation, the success of laser surgery depends largely on the surgeon's skill and determining whether the procedure is appropriate for you.
Intense light: The word laser stands for light amplification by stimulated emission of radiation. Laser beams are strong beams of light produced by electrically stimulating a particular material. A solid, a liquid or a gas is used. Lasers generally are named for the substances that produce them. Widely used lasers include the carbon dioxide laser and the argon laser.