Associate Professor of Surgery. Senior Consultant Colorectal & General Surgeon. MD PhD MRCS FRCS FASCRS FMAS FWAMS. General Secretary- Emirates Colorectal Society
I am often asked: How do you treat intersphincteric fistula? That is a relevant question as 1/3 of my fistula practice deals with referred patients failing muscle sparing surgery for IS fistula-MSS. In effect, MSS (Laser, VAAFT, LIFT,etc.) was devised for transphincteric and complex fistula, and not for IS fistula. There are two aspects of Intersphincteric fistula that need consideration: 1)The tract is less defined and when the external orifice is at the level of IS space (true one), MSS becomes merely a debridement of intersphincteric space and closure of internal orifice. Inducing coagulative necrosis in the IS space may actually open up space with higher chance of injuring the 4 mm IAS. 2) When the external orifice is lateral to the intersphincteric position, the tract may be more mature as crossing the corrugators/subcutaneous portion of EAS (false IS fistula). Results of MSS for IS fistula in literature are very scant, but higher failure rate is reported and expected. What do I do? If internal orifice is at or below dentate line: fistulotomy. If above the dentate line, discuss with patient: if has not opted for fistulotomy, a flap is the best treatment as a MSS technique in this scenario, plus laser at very low energy, if external orifice is lateral to intersphincteric space. #analfistula #colorectalsurgery #proctology #surgery #surgicaleducation #linkedincommunity #linkedinnetwork #healthcareinnovation #ESCRS #lasertreatment #medicaleducation #innovation #technology
Thanks for sharing these valuable knowledge
Bravo!!!!!!!
Anaesthesia technologist
2moIt's a privilege to work with you, leveraging your exceptional skills and sharing knowledge openly during surgeries. Your commitment to teaching and collaboration is truly admirable.