Surgical treatment is always the best option for anorectal abscesses. The antibiotics can’t give a definitive treatment, so the abscess becomes more severe and more extensive. The only reason for prescribing them is when the abscess cannot be detected because of not having an anal ultrasound examination. If the abscess is not drained surgically, then it may cause septicaemia.
Anal cancer is likely to happen in gay men, those who are infected by HIV and anal warts, people who are under steroid and immunosuppressive medication, men who have frequently anal sex and women with a background of dysplasia in their genitalia. Smoking increases significantly the chances of dysplasia (precancerous situation).
The anal cancer is a rare disease except of high-risk groups. For instance, homosexual men have 20-times greater chance of developing anal cancer than the general population. Approximately 50% of HIV-positive gay men will present in their life pre-malignant dysplasia in the area of the anus. 10% of HIV-positive gay men will finally develop anal cancer.
The exact location of the fistula (mapping) is discovered by performing an endo-anal ultrasound examination or an MRI (magnetic resource imaging). From our twenty-years experience, in our proctology clinic, we believe that the endo-anal ultrasound examination contributes to a better and more accurate understanding of the perianal fistula’s anatomy, compared to the MRI.
Fistula mapping with the endo-anal ultrasound examination helps the colorectal surgeon to identify:
The best known techniques for the management of high anal fistulas are the following:
Fistula laser closure (FiLaC®) is a simple, brief (up to 15 minutes), bloodless and painless method. Both of the sphincters (internal and external) are not injured, so fecal incontinence is completely avoided. It ensures the absolute control and precision during surgery and reduces the possibility of ablation or separation and all the associated risks of infection or other complications. At the same time, it requires minimal hospitalization (day clinic) and is ideal for the treatment of multiple relapses (in cases of failed surgical removals). The dimensions of the cyst/fistula are not a limitation while the flexibility of the fibres ensures a good access to the cyst/fistula in order to be treated well even if the anatomy is difficult. The length of the fistula is not a limitation, while the laser’s energy accelerates the healing process. Also, the treatment can be combined with other techniques for the best closing of the opening point.