ACUTE PARAPROCTITIS AFTER MODIFIED LASER ABLATION OF A SHORT COMPLEX RECTAL FISTULA: A CASE REPORT

Despite centuries of documented history, the treatment of rectal fistulas remains a relevant clinical challenge. Currently, a clear distinction exists between classical and modern techniques, including plastic closures, VAAFIT®, FiLaC®, and other methods. While modern approaches aim to achieve the efficacy of classical operations, they have demonstrated superior safety profiles in preserving sphincter function. This is particularly critical for patients presenting with symptoms of anal incontinence or those at high risk for its development. Clinical case: A 39-year-old man presented to the surgical department of the AIMS diagnostic clinic in June 2022 with painful discomfort in the perineal region and a small wound with scanty purulent-sanguineous discharge. His medical history began in August 2021 with an incision and drainage (I&D) procedure for acute paraproctitis, after which a rectal fistula developed. Routine examination established a clinical diagnosis of an anterior extrasphincteric rectal fistula of grade 1 complexity. Consequently, the first stage of treatment in June 2022 involved placement of a draining latex seton. One month later, the patient underwent laser fistula tract ablation using our modification of the FiLaC ® technique. On the tenth postoperative day, symptoms indicative of acute paraproctitis emerged. 3D ultrasound revealed a small collection of heterogeneous contents, located parallel to the projection of the former fistula tract. An emergency I&D was performed, and the subsequent postoperative course was uneventful. The final stage of treatment involved excision of the fistula tract and suturing of the sphincter. The postoperative wound healed over the following 38 days. Conclusions. Contemporary literature contains limited reports on early postoperative complications following laser ablation for rectal fistulas and offers scant data on their etiology or prevention. Analyzing and publishing such cases is vital both to elucidate the underlying causes of adverse outcomes and to establish evidence-based measures for their prevention.

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