Introduction
Coccyx fistulas are a common condition and are usually accompanied by a chronic course. The fistula outlets, which are usually located on the surface of the skin, become inflamed again and again. Painful boils develop, which must be opened or open spontaneously.
Ointments for coccyx fistulas or other remedies only provide short-term relief. The only way to completely heal a coccyx fistula is to remove it. Over the years, various surgical methods have been developed to remove the fistula tissue as completely as possible.
A further focus is on reducing the rate of relapse, which is relatively high despite good work. Many patients are afraid of surgery. Since the fistula tissue is completely removed, a relatively large, usually open wound develops in the breech area.
This must be regularly irrigated after the operation to prevent further infection and only closes after several weeks or months. The fear of the operation and the lengthy healing process leads many patients to do nothing to change their condition. However, an alternative has already been developed and is frequently used in specialized centers – laser surgical removal of the coccyx fistula, a laser treatment.
Laser treatment
Preliminary examinationPrior to laser treatment, the coccyx fistula is examined using ultrasound or MRI in order to plan the operation. The exact course of the fistula ducts is documented in order to protect as much healthy tissue as possible. If the fistula ducts are already very deep and have a connection to parts of the intestine or rectum, as may be the case in severe cases, a mirror image of the same is taken in advance (proctoscopy and endoscopy).
Other preliminary examinations include an ECG and laboratory blood tests. ProcedureThe patient is put under general anesthesia. Access to the deeper tissue of the coccyx fistula is made through an incision parallel to the gluteal fold.
The superficial fistula exits are cleaned and depilated before a laser is used for sclerotherapy. With the help of a scalpel, the wound is removed with millimeter precision and closed with thin sutures. The deep-seated fistula tissue can be removed via the parallel incision before another laser is used.
The laser has an antibacterial effect and reduces the size of the wound by so-called astringency. This means that the lasered tissue contracts, condenses and dries out. This results in less bleeding or inflammation.
With the help of ultrasound and irrigation, even the smallest runners of the coccyx fistula can be detected and removed by the laser. Once the laser treatment itself is complete, surgical instruments are then used. The wound is cleaned and scraped out, the bleeding is stopped and the wound is treated with a preparation.
This keeps the area sterile and thus supports wound healing. By changing the dressing every day, infections can be prevented as far as possible and the healing process is significantly shorter than with normal surgery. AftercareThe wound must be dressed with fresh bandages after the operation by the patient or other persons (family members, nursing staff, etc.).
If the operation was performed a week ago and no wound healing disorders are visible, the incision is closed with a few sutures. The stitches can be removed by the family doctor after the wound edges have grown together. According to experts, the treated area should also be depilated after the operation to avoid recurrence.
