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Frequent questions | |
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He asks the doctor | |
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Beginning | |
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FISTULA PERIANAL | |
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 DEFINITION YOU CAUSE DIAGNOSTIC TREATMENT I PREDICT TO CONSULT TO CONSULT |
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A fistula is an abnormal communication between an organ, a blood glass or the intestine and another structure. Generally, the fistulas are the product of traumas or surgeries, but also they can result from infections or inflammations of the affected organ. The fistula perianal talks each other in most of the occasions of an inflammatory process of the region that makes a detour to the year that produces a painful and annoying tumefaction with a secretion of purulent or fecal material (it even can present bloody material) that causes diverse symptomatology as itch, eczema of the surrounding skin and generally the spotted one with the underwear. Occasionally it can produce general symptoms as fever etc. In most of the cases, the origin of the fistula perianal is an abscess that could have been drained by surgical methods or did it of spontaneous form stopping like consequence this fibrous communication that produces the annoying secretion. In other occasions the origin of the fistula is tied to diverse disorders anorrectales that they study with constipation or chronic diarrheas motivating a malfunction of the device esfinteriano (the one that realizes the function valvular and of continence of the fecal material). Illnesses as the regional enteritis or the illness of Crohn, haemorrhoids, etc., can collaborate to fistula perianal. Other times, it is the instrumental exploration or the suffering of an illness in the abdomen like appendicitis, or infections in the horns or divertículos colónicos that are complicated, which cause the above mentioned fistulas. The diagnosis in most of the occasions is simple since the patient recounts this constant suppuration that motivates symptoms as the itch and the spot in the underwear. On having explored it, we must identify the conduit and establish the trip of the above mentioned fistula. Basing on the above mentioned trip we classify the fistulas in high or low, "intra", "inter" or "extraesfinterianas" depending on the place that they occupy with regard to the external sphincter, or subcutaneous, etc. This fact is very important since it is going to be decisive to choose the type of skill to be used. If there is realized an imaginary line that it divides to the anal orifice in two halves, previously (as regards the scrotum) and later (as regards the sacred bone), the fistulas that are established in the previous portion usually have a "straight" trip nevertheless the later ones have an uncertain and tortuous trip. The treatment of these processes is surgical and for it there have been used different skills that are going to depend on the clinical characteristics of the fistula. It is a question of eliminating the trip fistuloso and of leaving it to plane (without closing) so that it goes cicatrizando little by little. The achievement of the same one, that is to say his technical execution, it has many variants. There is the one who realizes it with cold scalpel (the conventional one) and the hemostasia (to obtain the coagulation of the glasses that they bleed) is carried out by means of tie of the glasses or with the electrical scalpel. The form of execution that most of the surgeons uses is by means of the electrical scalpel so much to realize the fistulectomía (eradication of the trajectory fistuloso) as to realize the hemostasia. The LASER scalpel manages to realize it previously recounted but with the technical progress of the precision and the most selective aptitude of coagulation. The released articles allude to these better skills in the LASER scalpel, but significant differences do not exist as for the result obtained with other methods. This means that the used scalpel does not influence at first the relapses appearance. It is necessary to emphasize that the relapse of the fistula after the surgical treatment of the same one is not an infrequent fact. Sometimes this relapse is associated with patients with illness of Crohn or another base illness that they cause in addition to the reproduction of the fistulas, the appearance of atypical fistulas in number and place doing his very difficult and complex surgical treatment. In other occasions the relapse takes place for present problems in the surgical field to be able to eliminate the whole territory fistuloso or the abscess or crypt producers of the same ones owed fundamentally to the trip (the later ones are usually more complex) or the place of the same one. In any case the surgical fistulas treatment recidivadas, bears an increase in the risk of injuring structures anorrectales, for it it is necessary to realize it with elegant end, as will tell to him his surgeon. The good result in the treatment of the fistula recidivada is not so much the type of scalpel that is used but the surgical finds, disposition of the field, type of fistula and associate illnesses and the possibilities of resection of the same one. |
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