Coccyx fistulas are a common ailment and are usually associated with a chronic course.
The fistula outlets, which are mostly on the surface of the skin, become inflamed again and again. There are painful boils that have to be opened or open spontaneously.
Ointments for a coccyx fistula or other remedies only provide temporary relief. The only way to completely heal a coccyx fistula is to remove it.
Various surgical methods have been developed over the years in order to be able to remove the fistula tissue as completely as possible. Another focus is on reducing the relapse rate, which is relatively high despite good work.
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Many patients are afraid of an operation. Since the fistula tissue is completely cleared out, a relatively large, usually open wound is created in the rump area.
This must be rinsed regularly after the operation to avoid further infections and only closes after several weeks to months. The fear of the procedure and the tedious healing process leads many patients not to change anything about their illness.
However, an alternative has already been developed and is often used in specialized centers - laser-surgical removal of the coccyx fistula, a laser treatment.
Read more on the topic: Surgery for a coccyx fistula
Preliminary examination
Before the laser treatment, the coccyx is using Ultrasonic or MRI examined in order to be able to plan an operation. The exact course of the fistula is documented in order to protect as much healthy tissue as possible. Are the Fistulous ducts already very deep and have a connection to parts of the intestine or RectumAs can be the case in severe cases, they are mirrored in advance (Proctoscopy and endoscopy).
Further preliminary examinations are a EKG and the laboratory technology Blood test.
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method
The patient is in a general anesthetic offset. Access to the deeper tissue of the coccyx is made through an incision that is made parallel to the gluteal fold. The superficial fistula exits are cleaned and depilatedbefore 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 fistula tissue can be removed via the incision made in parallel before a laser is used again.
This works antibacterial and causes the wound to shrink through so-called Astringency. That means that the lasered tissue contracts, compacts and dries up.
This reduces bleeding or inflammation. With the help of ultrasound and rinsing, even the smallest extensions of the coccyx fistula can be discovered and removed by the laser.
Once the laser treatment is complete, a surgical instrument is 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 daily dressing changes Infections can be largely prevented and the healing process is much shorter than with normal surgery.
Aftercare
The patient or other person (Family members, nursing staff etc.) be supplied with fresh bandages.
If the procedure was a week ago and no wound healing disorders are evident, the incision is included some seams locked.
The sutures can be removed by your doctor after the edges of the wound have grown together. According to experts, the treated area should also be treated after the operation depilated to avoid recurrences.
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The main disadvantage is the cost of such laser treatment for a coccyx fistula.
With around 7,000 - 10,000 euros (clinic dependent) the procedure is extremely costly and is used by the majority of statutory health insurance companies just partly paid.
Many patients are therefore unable to access this type of treatment.
The good effectiveness of a laser treatment and the minimization of the Post-treatment costs should also motivate statutory health insurance companies to include appropriate laser therapies for coccyx fistulas in their system.
The supply structure in Germany is another problem. Such laser treatments are mostly carried out in private clinics and the patient has to take longer journeys to undergo surgery on the one hand and to have the follow-up treatment on the other.
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