NAZAD NA USLUGEINFECTION CONTROL · MAPPING · CONTINENCE PRESERVATION

PERIANALNI APSCES I ANALNA FISTULA

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.

Autor medicinskog sadržaja: Efstratios K. KouroumpasStranica ažurirana: 30. август 2026.

PROMPT DRAINAGE WHEN NEEDEDSELECTIVE MRI / ULTRASOUNDSPHINCTER-PRESERVING PLAN

POGLEDAJTE OPERACIJE

Napomena: navigacija na stranici dostupna je na srpskom. Detaljan medicinski sadržaj ove stručne stranice trenutno je prikazan na engleskom.

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.

SIMPTOMI

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.

CONSTANT OR THROBBING PAIN

Pain that worsens while sitting or moving may indicate an active abscess.

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.

OPERACIJE

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.

KADA SE RAZMATRA: Throbbing pain, tender swelling or a deeper abscess confirmed clinically or on imaging.
ŠTA OBUHVATA: 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.

KADA SE RAZMATRA: Recurrent or complex fistula, multiple branches, previous surgery, a deep abscess or suspected Crohn's disease.
ŠTA OBUHVATA: 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.

KADA SE RAZMATRA: Simple low fistulas crossing a small amount of sphincter, with an acceptable functional risk.
ŠTA OBUHVATA: 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.

KADA SE RAZMATRA: Complex or high fistulas, active sepsis, a need for staged planning or perianal Crohn's disease.
ŠTA OBUHVATA: 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.

KADA SE RAZMATRA: Selected transsphincteric fistulas where sphincter preservation is a priority.
ŠTA OBUHVATA: 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.

KADA SE RAZMATRA: High or complex fistulas and cases in which fistulotomy would carry unacceptable functional risk.
ŠTA OBUHVATA: 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.

KADA SE RAZMATRA: Selected, mainly high or complex fistulas, after mapping and control of active infection.
ŠTA OBUHVATA: 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.

Originalna realistična anatomska ilustracija u edukativne svrhe — nije fotografija pacijenta.

PLANIRANJE I BEZBEDNOST

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.

PITANJA

ČESTA PITANJA

Kratki odgovori pre individualne hirurške procene.

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.

KLINIČKI DOKAZI

Konačan izbor zavisi od kliničke slike, anatomije i savremenih smernica.

01ASCRS · Anorectal Abscess and Anal Fistula Guideline 2022Clinical guideline for diagnosis, drainage and surgical optionsZVANIČNI IZVOR 02European Society of Coloproctology · Guideline 2024European guideline for cryptoglandular anal fistulaZVANIČNI IZVOR 03NHS · Anal fistulaPatient information on symptoms, diagnosis and treatmentZVANIČNI IZVOR 04ACPGBI · Anal abscess and fistulaPatient information from the British coloproctology associationZVANIČNI IZVOR 05NICE · FiLaCGuidance on laser treatment and uncertainty in efficacy evidenceZVANIČNI IZVOR

Sadržaj je informativan i ne zamenjuje pregled. Koristi, rizici i alternative razmatraju se individualno.

INDIVIDUALNA HIRURŠKA PROCENA

Prava operacija počinje pravom indikacijom.

Simptomi, nalazi i alternative razmatraju se na konsultaciji.

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