Introduction
Perianal fistulas and abscesses are among the most challenging conditions in proctology. They significantly impact quality of life and often require specialized management for successful resolution.
What is a Perianal Abscess?
A perianal abscess is an acute infection characterized by a localized collection of pus near the anus. It usually results from blocked anal glands but can also stem from conditions like Crohn’s disease or hidradenitis suppurativa.
Key Features:
- Severe localized pain and swelling
- Redness and heat around the anus
- Possible fever if deep abscess
- Spontaneous drainage in some cases
What is a Perianal Fistula?
A fistula is an abnormal channel connecting the internal anal canal to the external skin. It often follows a previous abscess that did not heal properly.
Symptoms Include:
- Skin irritation and discomfort
- Persistent or intermittent discharge
- Recurrent swelling or infection
Why Immediate Diagnosis and Mapping Are Critical
Delayed or incorrect treatment increases the risk of complications like sphincter damage, chronic infection, and complex fistula formation. Accurate mapping before surgery is essential to prevent recurrence and protect continence.
Diagnostic Methods
1. Endoanal Ultrasound
- Gold standard for abscess and fistula mapping
- Immediate, real-time imaging
- Determines location, tract course, internal opening
- Identifies sphincter involvement
- Performed without anesthesia, painless
2. MRI (Magnetic Resonance Imaging)
- May miss small tracts not filled with fluid
- Helpful in complex or recurrent cases
- More expensive, less immediate than ultrasound
Immediate Surgical Drainage for Abscess
An abscess must be surgically drained as early as possible. Antibiotics alone cannot cure it and often delay proper management.
Risks of Delayed Drainage:
- Sepsis
- Progression to complex fistula
- Sphincter destruction
Modern Surgical Treatments for Fistulas
1. Fistulotomy
- Simple fistulas only
- Involves cutting open the tract
- High success, slight incontinence risk if near sphincter
2. Seton Placement
- Temporary suture placed through fistula tract
- Allows drainage and gradual healing
3. FiLaC (Fistula Laser Closure)
- Minimally invasive laser procedure
- Preserves sphincters
- Effective for high and complex fistulas
4. VAAFT (Video-Assisted Anal Fistula Treatment)
- Minimal cutting, better sphincter preservation
- Endoscopic visualization and closure
Our Clinic’s Advantages
- 25 years of specialized experience in anal ultrasound mapping
- Immediate diagnosis with in-office ultrasound
- All modern surgical techniques available (FiLaC, VAAFT, Setons, Laser)
- Focus on continence preservation
- Patient-centered approach: individualized treatment selection
Conclusion
Perianal abscesses and fistulas require expert management. With the right diagnosis and tailored therapy, cure rates are high, and complications are minimized. Trust our clinic for accurate diagnosis, modern treatments, and compassionate care.
