Radiofrequency fistulotomy: a better alternative for treating low anal fistula

Pravin Jaiprakash Gupta

doi:10.1590/s1516-31802004000400008

Abstract

Wide varieties of approaches are employed in dealing with low anal fistula. However, the simple method of laying open the fistula tract (fistulotomy) is still considered to be the favored one. A modified approach to the procedure of fistulotomy is discussed. This study describes the procedure, which used a technique of radiofrequency surgery, and its outcome in 232 patients with low anal fistula. The patients were followed for a period of 15 months. The patients were discharged on the same day as the procedure. The mean period off work was four days. The average healing time recorded was 67 days. Four wound complications in the form of premature closure of the external wound were noted, which required trimming of the edges. Two of these wounds remained unhealed. The recurrence rate was 1.7%. In this era when the emphasis is on criteria like the minimization of hospital stay, reduction of postoperative pain, early resumption of work and low and comparable recurrence rates, there is a future for the procedure of radiofrequency fistulotomy.

Highlights

The classic lay-open technique is still the most favored procedure for anal fistula
In this era when the emphasis is on criteria like the minimization of hospital stay, reduction of postoperative pain, early resumption of work and low and comparable recurrence rates, there is a future for the procedure of radiofrequency fistulotomy
The mean procedure time was 13 minutes. This was recorded by an independent observer, and was calculated as the total time required from inserting the probe in the fistula tract to the application of dressing over the wound

Summary

Introduction

Slitting the complete tract, starting from the external opening and proceeding to the internal opening, is the basis for traditional fistulotomy.[1]. This conventional procedure at times encounters brisk bleeding from the cut surfaces. The intracellular tissue water that provides the resistance in the process is instantly vaporized without causing heat and damage, unlike what takes place in electrosurgery. This tissue vaporization results in significant hemostasis without burning the tissue.[2] In addition, there is no danger of the patient suffering any shock or burn in the process. The surgical radiofrequency generator that we have been using is the dual frequency 4 MHz unit from Ellman International (Hewlett, New York)

Methods

Results

Discussion

Conclusion