Persistent discharge in the anal area, recurring abscesses, and staining of undergarments… Most of my patients who apply to my clinic with these complaints carry the worry: “Doctor, I have a fistula, but I am very afraid of surgery; what if I lose bowel control?”
You are right; the treatment of an anal fistula (perianal fistula) is a sensitive process that requires surgical experience. However, with modern technologies and correct surgical planning, the feared risk of “incontinence” has now been minimized.
As a General Surgery Specialist, I would like to transparently explain how perianal fistula surgery is performed and where laser technology stands in this disease.
What is a Fistula and Why is Surgery Essential?
An anal fistula is an abnormal tunnel formed between the last part of the intestine (anal canal) and the skin of the buttocks. One end of this tunnel is inside, and the other is outside. Because stool and bacteria constantly leak from the inside, this tunnel never closes on its own. It cannot be dried out with medication or creams.
The only way to treat it is to eliminate this tunnel. However, the tunnel usually passes through the muscles (sphincters) that allow us to hold our stool. This is where the skill of the surgeon comes into play: How do we destroy the tunnel without damaging the muscles?
Latest Developments in Perianal Fistula Surgeries: Laser and LIFT
Recent developments in perianal fistula surgery focus entirely on preserving the muscles (sphincter-preserving surgery).
- Laser Treatment (FiLaC): Our patients frequently ask about the laser. In this method, a thin laser fiber is sent into the tunnel, and the tunnel is closed (sealed) by burning it from the inside.
- Advantage: No incision, muscles are not cut, pain is minimal.
- Disadvantage: It is not suitable for every fistula. In curved, branched, or very wide tunnels, the success rate of the laser may decrease. We encounter patients with quite high recurrence rates and sphincter damage.
- LIFT Method (Ligation): This involves finding the tunnel between the muscles, ligating (tying) it, and cutting it. The muscles are not touched at all; only the disease is eliminated. In cases where the tract is not removed, recurrence rates are high.
- Seton Application: This remains one of the most reliable methods. A string (seton) passed through the tunnel ensures the drainage of inflammation and brings the tunnel under control. It is particularly important for protecting the muscle in complex cases. However, a long dressing process or a supplementary second surgery is required for full treatment.
- Fistulectomy and Flap Combination: I believe this method is where academic studies will lead in the near future. Research on this topic continues. It is a method that can save patients from a distressing process like the seton while also protecting the muscles. This method, which we use frequently, offers a comfortable recovery period for both the patient and the physician and is successful in terms of preventing recurrence. For success, sufficient experience in fistula and flap surgery, as well as the use of advanced imaging equipment, is necessary.
How are Perianal Fistula Laser Treatment Prices Determined?
Patients often search the internet for perianal fistula laser treatment prices. However, in fistula treatment, the price varies according to the complexity of the disease rather than the device used (laser probe cost, etc.). We have mentioned our stance (quite distant) regarding the use of lasers for perianal fistula. Please do not insist to your physician that you want “laser.” The method you want could become your regret.
While a simple fistula can be resolved with a 15-minute procedure, a complex (horseshoe) fistula may be more difficult and even require staged surgery. What matters is not choosing the “most expensive” or “most technological” method, but determining the method most suitable for your fistula map (MRI results). Using “laser” alone in the wrong patient group can cause the disease to recur and your money to be wasted.
How Long Does Perianal Fistula Surgery Take?
The duration of the operation also varies according to the type of fistula.
- Simple Fistula / Fistulotomy: This process, where the tunnel is opened up, takes an average of 15-20 minutes.
- Laser (FiLaC): Takes about 30 minutes including preparation.
- Complex Cases (LIFT / Flap): May take 45-60 minutes as delicate dissection is required.
Regardless of the method applied, you will feel no pain during the procedure as it is performed under general or spinal anesthesia.
Conclusion: Technology is a Tool, Surgery is Essential
In fistula treatment, a generalization like “Laser is good, the knife is bad” is incorrect. In our clinic, we do not apply laser (FiLaC) even if your fistula is suitable. Instead, we prefer methods that are less invasive, have low complication rates, and are more successful.
Our priority is not a “fast” recovery, but a “permanent and safe” one.
Assoc. Prof. Dr. Yahya Çelik General Surgery Specialist & Proctology
Legal Disclaimer: This content is for informational purposes only. Please consult your doctor for definitive diagnosis and treatment.
