Technically most advanced solutions for intimate problems – Continence-maintaining treatment for anal fistulae
Dr. Skander Bouassida is chief physician at the Coloproctology Clinic of the Vivantes Humboldt-Klinikum in Berlin and works as an abdominal surgeon, rectal specialist and proctologist. He has special training especially in the treatment of colon, rectum and anal diseases and is certified in minimally invasive and robot-assisted surgery. In the specialized consultation hours of the Outpatient Operative Centre ("AOZ"), patients find a first place to go for their concerns and understanding, empathetic advice and care.
The Clinic for Coloproctology provide a very broad spectrum of treatments and therapies. What is special with your therapy approach?
Dr. Skander Bouassida: Rectal and colon diseases touch the very last taboo of our intimacy. The subject is instinctively unpleasant for patients and even doctors. The development of medical knowledge and high-tech procedures in coloproctology in recent years has led to a shift from so-called general surgery to specialized coloproctology, similar to how cardiology, for example, has split off from general medicine. On the one hand this concentration on the best possible high-tech medicine in combination with, at the other hand, a very understanding and personal approach to the practical intimate things of our patients – this is the special aspect of the therapeutic approach of my team. This allows – with excellent results – the preservation of continence and a comparatively painless treatment.
What role do robot-assisted surgery and minimally invasive procedures play in proctology?
Dr. Skander Bouassida: A very decisive one. Every affected person wants the smallest possible, safest and least painful procedure. The times are over in which large operations were usually leading to mutilations. What makes life much easier for patients means a much greater technical effort for the physician. With minimally invasive procedures we can safely operate via small stitches into the abdominal cavity or via natural body orifices. The robot arms, which are remote-controlled by me, are particularly fine and precisely movable and support me during the difficult interventions in the narrow pelvis.
How do you usually treat anal fistulas?
Dr. Skander Bouassida: Anal fistulas are pathological inflammatory duct connections between the intestine and buttocks or between the intestine and the vagina. Anal fistulas almost always require surgery. For years, we have basically applied a multi-stage, minimally invasive, stage-adapted concept: First, the fistula must be cleaned in a small procedure and freed from acute infections and non-segregated fluids. This makes the fistula tract as small as possible. Then, depending on the course of the fistula ducts, the definitive restoration is made in a second procedure. We combine techniques such as the rectal wall flap method, the LIFT method, the laser method FiLaC® or anal sphincter plastic surgery with e.g. levator plastic or Gracilis flaps... In any case, a simple sphincter muscle severance – with all consequences – is always avoided. We have been using the laser method since 2015 for anal fistulas, pilonidal fistulas, pathological changes at the anus and tumors as well as in the abdominal cavity.
How exactly does the procedure with the FiLaC® method work?
Dr. Skander Bouassida: The procedure is performed under mask anesthesia – the patient does not notice anything. First a locoregional anesthesia is performed, so that after the anesthesia has subsided there is little pain. The anal fistula is then probed, photographed, cleaned (scraped) with a curette, brushed and rinsed. The inner opening is cut out very sparingly (causal gland) and closed with a suture. In the case of large findings, the suture is secured with an intestinal wall flap. Then the entire pathological fistula duct is simultaneously destroyed and glued (photocoagulation) using the special laser probe of the FiLaC® method with laser light energy. The outer opening is cut out in order to ensure a clean discharge of secretion until safe healing.
How long does it take for the patient to go back to his or her daily activities?
Dr. Skander Bouassida: Compared to other proctological operations, patients are quickly fit again, although a wound in the intimate area is generally unpleasant. The discharge usually takes place on the 2nd day, when food, intestinal activity and intimate care are working out fine. Most patients get along well with everyday life from the 3rd day onwards. Special bandages are not necessary. The wound secretion lasts 2 - 3 weeks, a simple wound pad is sufficient. The pain's improving a lot sooner. The definitive wound healing can take longer, but the patients are still usually fully resilient.
Does the health insurance pay for the laser treatment?
Dr. Skander Bouassida: Fistula surgery is covered by health insurance, but not the additional costs of laser therapy. These costs have so far been borne by our certified Coloproctology Centre at the Vivantes Humboldt-Klinikum – the medical benefit seems clear to me for suitable patients. Our patients therefore do not have to fear any additional costs.
Further information: www.vivantes.de