Treatment of perianal and anal fistula
A perianal or anal fistula, commonly known as a fistula of the rectum, is a chronic tunnel between the rectum and the skin that repeatedly becomes inflamed and discharges fluid, and cannot be healed with ointments or antibiotics. It can only be closed by a procedure aimed at sparing the sphincter as much as possible. At the Dermarevolta clinic in Bratislava, we precisely map the course of the fistula and, depending on its type, choose either FiLaC laser treatment or another approach. Most procedures are performed on an outpatient basis under local anaesthesia, as day surgery.
How we treat perianal fistulas
Treatment of an anal fistula is not a single universal procedure; the choice depends on the course of the tract and how much of the sphincter it involves. We therefore always begin with a thorough examination, supplemented if needed by an ultrasound of the perianal region, to reliably map the course of the fistula and choose a method that spares continence as much as possible. Below you will find an overview of the procedures we use at the Dermarevolta clinic in Bratislava for perianal fistulas. The prices are taken directly from our price list, and we will draw up a treatment plan after a personal examination.
Examination and mapping of the fistula
The foundation of the entire treatment. The proctologist assesses both the external and internal opening of the fistula and, if needed, supplements this with an ultrasound of the perianal region to reveal the course of the tract and its relationship to the sphincter. The method is chosen accordingly.
FiLaC laser fistula closure
A gentle, minimally invasive method. A thin laser fibre closes the tract from the inside without a large incision and without cutting the sphincter, so the risk of impaired continence is low. The procedure is performed on an outpatient basis under local anaesthesia.
Treatment of a subcutaneous anal fistula
For a superficial, subcutaneous fistula that does not involve the sphincter muscle, we choose a simpler procedure. The tract is treated directly, healing tends to be faster, and the procedure is one of the more affordable options.
Ultrasound diagnosis of the fistula tract
Ultrasonography of the perianal region shows the course of the fistula, any branching and possible hidden pockets. This helps ensure that no part of the tract is missed, as an overlooked section could otherwise remain and lead to recurrence.
Distinguishing from an abscess and other causes
A fistula often follows a previous perianal abscess. The proctologist therefore assesses whether there is an acute inflammation that needs to be treated first, and distinguishes the fistula from other causes of discharge around the rectum.
Follow-up after FiLaC treatment
After the procedure, we monitor the area to ensure the wound heals properly and to detect any recurrence in good time. You will receive clear aftercare instructions that help speed up recovery in this sensitive area.
Cost of perianal fistula treatment
Prices are given in advance and are paid directly at the clinic, with no hidden fees. The final amount depends on the type of fistula and the method chosen, so we can only confirm it after an examination and mapping of the tract. Below you will find prices from our price list, including ultrasound diagnostics and the FiLaC laser method. Treatment of a subcutaneous fistula is one of the more affordable options, while laser closure is a more demanding procedure.
Gergely Kremeshnyy
Proctologist and surgeon specialising in the rectum and surrounding areaBoth the examination and the procedure for perianal fistula are carried out by Gergely Kremeshnyy, a proctologist and surgeon specialising in conditions of the rectum, anal and perianal region. He completed his general medicine studies at Uzhhorod National University and, in practice, focuses on proctology, rectal surgery and minimally invasive procedures for these conditions.
This means you have diagnosis, ultrasound mapping and treatment all with a single specialist in rectal conditions. When treating a fistula, he places emphasis on precisely determining the course of the tract and choosing a method that spares the sphincter as much as possible, as well as on clearly explaining why follow-up care is important with this condition.
“With a fistula, the most important thing is to know the exact course of the tract. Once we’ve mapped it, we can choose an approach that closes the fistula while preserving the sphincter as much as possible. The goal is to resolve the problem while maintaining continence.” – Gergely Kremeshnyy
When to consider seeing a proctologist
- You have a small opening near the anus that leaks pus, discharge or blood, and your underwear often gets soiled.
- The area around the anus becomes repeatedly inflamed, painful or swollen, and these symptoms keep coming back over time.
- You have had a perianal abscess that drained or was treated, but discharge from the anal area persists.
- Ointments, sitz baths and antibiotics haven't resolved the problem, and symptoms return once you stop using them.
- You feel a hard cord or a painful spot near the anus and aren't sure what condition it actually is.
- You want a sphincter-sparing approach, as maintaining continence matters to you.
Why trust us with your fistula treatment
Precise mapping of the tract
We determine the course of the fistula through examination and, if needed, ultrasound of the perianal area. This tells us where the tract runs and how much of the sphincter it involves, so no hidden branch is missed.
Sphincter-sparing methods
Depending on the type, we choose FiLaC laser treatment or treatment of a subcutaneous fistula, neither of which cuts through the sphincter muscle. The goal is to close the fistula while protecting continence as much as possible.
Outpatient, same-day procedure
Most procedures are performed on an outpatient basis under local anaesthesia, as day-case surgery. You go home the same day, with no need for hospitalisation.
Abscess kept under control
A fistula often develops after a perianal abscess. We therefore assess whether there is an acute purulent infection that needs to be treated first, so that fistula treatment has a lasting effect.
One specialist for the whole area
Examination, ultrasound and the procedure itself are all carried out by the same doctor specialising in the anal area. You won't need to explain your condition repeatedly, and the whole process flows smoothly from one step to the next.
Follow-up and transparent pricing
After the procedure, we regularly monitor healing so that any recurrence is caught early. You'll know the prices in advance, and we'll confirm the final amount after examination, depending on the type of fistula.
Frequently asked questions about perianal fistula treatment
No, neither a perianal nor an anal fistula heals spontaneously, and without treatment it usually persists or becomes repeatedly inflamed. This anal fistula is a chronic tract between the rectum and the skin that ointments and antibiotics cannot permanently close, only temporarily calm the inflammation. It can only be closed through a procedure, so it's worth seeing a proctologist as soon as possible.
Treatment depends on the type of fistula and how much of the sphincter it involves. We first map the course of the tract, using ultrasound if needed, and then choose an approach:
- FiLaC laser treatment for fistulas involving the sphincter, with preservation of continence,
- a simpler procedure for a superficial subcutaneous fistula,
- for more complex cases, an approach tailored to the course of the tract.
The goal is to close the fistula while sparing the sphincter as much as possible.
FiLaC is a laser method for closing a fistula, in which a thin fibre seals the tract from the inside without a large incision and without cutting through the sphincter. This is why the risk of continence problems is low, and healing tends to be more comfortable than after conventional surgery. The procedure is performed on an outpatient basis under local anaesthesia. According to our price list, FiLaC laser fistula surgery costs €1,400.
The aim is precisely to prevent this. The anal sphincter is responsible for continence, which is why we choose methods that spare it as much as possible, such as FiLaC laser treatment or treatment of a subcutaneous fistula. In more complex fistulas involving the muscle, the risk is assessed individually. Precise mapping of the tract before the procedure helps reduce this risk.
Áno, fistula veľmi často nadväzuje na prekonaný perianálny absces. Absces je akútny hnisavý zápal, a keď sa vyprázdni, môže po ňom zostať trvalý kanál, teda fistula. O akútnom zápale píšeme na stránke liečba perianálneho abscesu. Preto pri fistule vždy posúdime, či nejde súčasne o aktívny absces.
Recurrence is possible with fistulas, depending on how complex the tract is and whether its entire course was identified. That's why we map the fistula precisely before the procedure and monitor healing at follow-up visits afterwards. If new discharge or inflammation appears, we address it promptly. Minimally invasive methods can be repeated if needed.
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