A Novel Combination of Fistulectomy & Leonardo Laser Therapy to Cure Complex Recto-inguinal Fistula

This is a story of a long (4-5 years) suffering from fistula, of a 31 years old male patient. It started with fever and severe abdominal pain. While working at the Central Industrial Security Force (CSIF), he had a very stressful schedule with a lot of traveling all through work hours. Being a workaholic by heart, health took a back seat in his life.

The pain & fever were neglected with mere medications for a few weeks, which later aggravated in a few years and led to internal pus formation in the abdomen. Initially, the patient had no complaints such as swelling at the rectum. However, due to consistent sitting in one place & pus accumulation, he gradually started facing discomfort, bleeding stools and extreme pain. At this time, he consulted a local surgeon for immediate attention & cure. He was advised to do an Ultrasonography of abdomen & pelvis that showed pus collection in the right side of the abdomen. Later, he underwent a surgery for the same.

For a few weeks, he was totally relieved from the problem but after two months, the same symptoms began to re-occur. He got operated thrice for the drainage of pus, since the problem was seen to be recurrent every time.

Until then, the symptoms related to the rectum persisted. He was very frustrated, as his daily routine was getting hampered a lot. Later again, he was detected with pus collection in the abdomen; this time in the left side. He was frustrated enough with the ailment by the time and decided to seek a second opinion from a popular and expert surgeon in the city.

A surgeon advised him to undergo an MRI Fistulogram, which showed a big fistulous tract from the left inguinal region to the rectum (medically known as recto-inguinal fistula). He was operated for the draining pus and was addressed with a colostomy bag. This was certainly, the final hope for the patient but to his surprise, the problem re-occurred again! Stool was diverted from the abdomen. At this point, his condition was near to worst. It was like bearing the pain to live with the colostomy bag.

He was further referred to Fistula Specialist Dr. Ashwin Porwal, a renowned Colorectal Surgeon & Founder of Healing Hands Clinic and HOD of Proctology Clinic at Apollo Jehangir Hospital, which is a specialty centre for all anorectal ailments. He was further diagnosed of Complex Recto-inguinal Fistula. The findings showed that he had a fistula track that was formed from the left inguinal region (left lateral wall of pelvis) to the rectum. One opening was at the left lateral wall of pelvis and another at 6 o’clock of anus.

As the fistula had a long pathway (25 cm), Fistulectomy wasn’t possible. Thus, from the inguinal region, 7-8 cm fistulous tract was taken out and partial closure of the tract was performed. Again a 3-4 cm fistulous tract from the anal region was extracted (fistulectomy) and a total closure was performed with the help of the latest device Leonardo Laser, introduced recently by Dr. Ashwin Porwal for the first time in India. A very small opening was intentionally left open from the inguinal region & resultant wound was not completely closed, to let it heal on its own.

This patient was hospitalized for 3 days, was on IV Antibiotics. Post discharge he was advised a follow up of once in 2 weeks, for 2 months. A course of antibiotics & anti-inflammatory & antacid medications was prescribed for a month. Commenting on the aftercare follow up of the patient, he’s absolutely stable performing his normal routine at home. He has taken leave from work to recover completely.

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