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In humans, there is a jagged line on the intestinal surface at a distance of approximately 1.5-2 cm from the entrance of the anus. This line is called the dentate line. Along the dentate line, there are anal glands that secrete fluid into the anus through small ducts all around. As a result of the duct openings of these glands clogged with small hardened stools or undigested food particles, their glands cannot discharge into the anus and the anal glands swell. If this situation is prolonged, the accumulated fluid becomes inflamed and an abscess develops around the anal gland. If it is not intervened, the pressure inside this abscess will increase continuously, the abscess will expand and will evacuate from the place where it has the least resistance. This may be the skin, or the inside of the anus or large intestine. In the case of an opening on both sides, this creates a path that should not normally exist between the atmosphere and the intestinal tract, which is called a perianal fistula.
Perianal abscess and fistula can actually be considered as two stages of the same disease. The disease starts as an accumulation of inflammation (abscess) around the anus, if it is treated on time, it remains at that stage and heals. However, if time is lost in the treatment, a fistula, which is the second stage of the disease, occurs. A fistula, by definition, means a path that should not normally exist between two hollow organs (stomach, intestine, etc.) or between a hollow organ and the atmosphere (external environment). Perianal fistula is the opening of the inside of the anus or large intestine to the outside through a tunnel, that is, to the skin, which is not normal. The abscess formed in the first stage will prepare the infrastructure of this road.
When a perianal abscess is detected, it should be evacuated in the operating room by planning the operation as quickly as possible. It is not suitable to be evacuated under outpatient clinic conditions or with local anesthesia due to pain. MRI may be required to obtain anatomical information about the abscess before surgery. This is necessary in order to avoid surprises in the correct intervention and surgery. The presence of fistula is investigated during the operation, and if it is detected, the first session treatment is also performed. If not, only the abscess is drained and the operation is completed.
After the abscess is treated, a fistula may develop in the next period, even if it is detected in the first operation. After the fistula is detected, its treatment takes several months and requires several sessions of treatment. These treatments can be performed in the operating room or outpatient clinic, but they generally do not cause pain to the patient and do not require hospitalization.
The fistula is divided into four according to its location in the tissue and the way it cuts:
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intersphincteric and superficial
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transsphincteric
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suprasphincteric
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Extrasphincteric
The patient is operated on the day the abscess is diagnosed and can be sent home within a few hours. If a fistula develops in the next period, 2-4 more interventions are required for this purpose and the treatment takes a few months. Fistula treatment and afterwards is not painful for the patient. In the treatment of fistula, a piece of rubber or thread is passed through the fistula path, like an earring, and tied. The body sees this substance as foreign and wants to throw it out, and in this process, it fills the remaining spaces with healing tissue. Several sessions can be repeated with this work, it is called a seton application. In addition to the Seton application, it is possible to close the fistula with laser or fillers.