CONSTANT OR THROBBING PAIN
Pain that worsens while sitting or moving may indicate an active abscess.
ZURÜCK ZU DEN LEISTUNGENINFECTION CONTROL · MAPPING · CONTINENCE PRESERVATION
PERIANALABSZESS UND ANALFISTEL
A perianal abscess is usually the acute infection, while an anal fistula is an abnormal tract that may persist or recur after drainage. An abscess usually requires timely drainage; fistula treatment is planned according to the tract and its relationship with the sphincters. Assessment is available in Athens for patients from Attica and throughout Greece.
PROMPT DRAINAGE WHEN NEEDEDSELECTIVE MRI / ULTRASOUNDSPHINCTER-PRESERVING PLAN
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ELIXIS · ADVANCED CARE
Abscess or fistula? The distinction changes treatment
Diagnosis is based on history and clinical examination. Pelvic MRI or endoanal ultrasound is not required for every simple case, but may be particularly useful for deep, complex or recurrent fistulas, after previous surgery or in Crohn's disease. In selected cases, the anatomy is confirmed by examination under anaesthesia.
SYMPTOME
Symptoms that merit assessment
A perianal abscess is an acute collection of pus near the anus and usually requires prompt drainage. An anal fistula is a tract connecting the anal canal to the skin and often follows an abscess, causing recurrent swelling or discharge.
PAINFUL SWELLING
A tender lump, redness and warmth around the anus require prompt assessment.
FEVER OR CHILLS
Fever, chills or significant systemic illness may accompany a deeper or progressing infection.
PURULENT DISCHARGE
Pus, blood or foul-smelling fluid from a small opening near the anus is a common fistula symptom.
SWELLING–DRAINAGE CYCLE
Episodes in which swelling improves after drainage and later returns are characteristic.
SKIN IRRITATION
Persistent moisture and discharge may cause itching, burning or skin irritation.
Spontaneous drainage may reduce pain but does not confirm that the infection has resolved. Recurrent, multiple or complex fistulas, particularly with diarrhoea, weight loss or abdominal symptoms, require assessment for Crohn's disease or another underlying cause.
EINGRIFFE
Treatment according to anatomy and disease phase
An acute abscess is treated first as an infection. There is no single fistula procedure suitable for everyone: the safest option depends on tract height, branches, sphincter involvement, previous operations and baseline continence.
01DRAINAGE
INCISION & DRAINAGE OF A PERIANAL ABSCESS
The main treatment for a formed collection of pus is timely surgical drainage.
- WANN ES ERWOGEN WIRD
- Throbbing pain, tender swelling or a deeper abscess confirmed clinically or on imaging.
- WAS DER EINGRIFF UMFASST
- The collection is opened and adequately drained. Antibiotics do not replace drainage and are used selectively, such as for extensive cellulitis, systemic infection or immunosuppression.
02MAPPING
FISTULA MAPPING
The tract and its relationship with the sphincters determine which procedure is safe.
- WANN ES ERWOGEN WIRD
- Recurrent or complex fistula, multiple branches, previous surgery, a deep abscess or suspected Crohn's disease.
- WAS DER EINGRIFF UMFASST
- Clinical examination is combined, when it will affect planning, with pelvic MRI or endoanal ultrasound. Imaging is selective rather than routine for every simple case.
03FISTULOTOMY
FISTULOTOMY
The tract is laid open so it can heal from the base to the surface.
- WANN ES ERWOGEN WIRD
- Simple low fistulas crossing a small amount of sphincter, with an acceptable functional risk.
- WAS DER EINGRIFF UMFASST
- Anatomy is confirmed before division. Fistulotomy is unsuitable when the amount of muscle division required could materially affect continence.
04SETON
DRAINING SETON & STAGED TREATMENT
A loose seton keeps the tract open, permits drainage and controls infection without intentional sphincter division.
- WANN ES ERWOGEN WIRD
- Complex or high fistulas, active sepsis, a need for staged planning or perianal Crohn's disease.
- WAS DER EINGRIFF UMFASST
- It often provides a safe first stage before definitive surgery. A draining seton usually controls inflammation but is not necessarily definitive treatment by itself.
05LIFT
LIFT PROCEDURE
The fistula tract is ligated and divided in the intersphincteric plane without intentional sphincter division.
- WANN ES ERWOGEN WIRD
- Selected transsphincteric fistulas where sphincter preservation is a priority.
- WAS DER EINGRIFF UMFASST
- The intersphincteric tract is identified, isolated and closed. Healing is affected by branches, previous operations and Crohn's disease.
06ADVANCEMENT FLAP
ADVANCEMENT FLAP
The internal opening is closed and covered with a flap of healthy tissue, aiming to avoid wide sphincter division.
- WANN ES ERWOGEN WIRD
- High or complex fistulas and cases in which fistulotomy would carry unacceptable functional risk.
- WAS DER EINGRIFF UMFASST
- The tract is cleaned, the internal opening is closed and covered with a rectal or anodermal flap. Recurrence or a change in continence remains possible.
07FiLaC
FiLaC LASER TREATMENT
A radial fibre applies controlled energy inside the tract, aiming to close it without intentional sphincter division.
- WANN ES ERWOGEN WIRD
- Selected, mainly high or complex fistulas, after mapping and control of active infection.
- WAS DER EINGRIFF UMFASST
- FiLaC may limit surgical trauma, but does not guarantee healing and has not been proven superior for every fistula. Comparative and long-term evidence remains limited, and repeat or different surgery may be required.
Originale realistische Anatomiedarstellung zu Lehrzwecken — kein Patientenfoto.
PLANUNG & SICHERHEIT
Protecting continence and managing recurrence risk
No technique guarantees healing in every patient. Persistence or recurrence and continence risk depend on tract height and branches, sphincter involvement, baseline function, previous surgery and Crohn's disease. In complex cases, the safest treatment may require more than one stage.
MAPPING
The relationship between tract and sphincters comes before procedure selection.
CONTINENCE
Baseline function, previous childbirth and earlier operations affect safe planning.
CROHN'S DISEASE
Multiple or recurrent fistulas may require combined gastroenterology and surgical care.
FOLLOW-UP
Healing, drainage and signs of recurrent infection are reassessed after treatment.
FRAGEN
HÄUFIGE FRAGEN
Kurze Antworten vor der individuellen chirurgischen Beurteilung.
01Are an abscess and a fistula the same?
No. An abscess is an acute collection of pus, while a fistula is an abnormal tract that may remain after infection.
02Are antibiotics enough for a perianal abscess?
Usually not once a collection has formed. Drainage is the main treatment; antibiotics are added only in selected clinical circumstances.
03Does everyone need an MRI scan?
No. MRI is used selectively for a deep, complex or recurrent fistula, after previous surgery or in Crohn's disease, when it will change planning.
04Which is the best fistula operation?
There is no single operation suitable for everyone. Choice depends mainly on tract anatomy, sphincter involvement, baseline continence and previous surgery.
05What is a seton, and does it mean treatment has failed?
A seton is a dedicated thread or loop that maintains drainage. It is often a deliberate first stage to control infection and protect the sphincters, not a failure.
06Is FiLaC laser suitable for every fistula?
No. It may be considered in selected cases, but it does not guarantee healing and has not proved superior for every anatomy. Selection follows mapping and infection control.
07Is there a risk of incontinence?
Risk varies with anatomy and the procedure. The sphincters and baseline continence are therefore assessed before treatment is selected.
08Can a fistula recur?
Yes. Recurrence is influenced by complex anatomy, branches, active infection, previous operations and Crohn's disease. Follow-up is part of treatment.
09When is urgent medical assessment needed?
High fever or chills, rapidly worsening pain, swelling or redness, and significant systemic illness require urgent assessment, particularly in diabetes or immunosuppression.
KLINISCHE EVIDENZ
KLINISCHE EVIDENZ
Die endgültige Wahl richtet sich nach Befund, Anatomie und aktuellen Leitlinien.
01ASCRS · Anorectal Abscess and Anal Fistula Guideline 2022Clinical guideline for diagnosis, drainage and surgical optionsOFFIZIELLE QUELLE02European Society of Coloproctology · Guideline 2024European guideline for cryptoglandular anal fistulaOFFIZIELLE QUELLE03NHS · Anal fistulaPatient information on symptoms, diagnosis and treatmentOFFIZIELLE QUELLE04ACPGBI · Anal abscess and fistulaPatient information from the British coloproctology associationOFFIZIELLE QUELLE05NICE · FiLaCGuidance on laser treatment and uncertainty in efficacy evidenceOFFIZIELLE QUELLE
Diese Informationen ersetzen keine ärztliche Untersuchung. Nutzen, Risiken und Alternativen werden individuell besprochen.
INDIVIDUELLE CHIRURGISCHE BEURTEILUNG
Der richtige Eingriff beginnt mit der richtigen Indikation.
Beschwerden, Untersuchungen und Alternativen werden gemeinsam geprüft.
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