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Fistura review by Dr Bouchard
Radiofrequency in the treatment of anal fistulas: a (good) alternative to fistulotomy?
My personal results in recent years with the Fistura procedure:
60% prolonged closure (at least 12 months follow-up), on clinical assessment for crypto-glandular fistulas and on clinical and MRI assessment for Crohn’s disease related anal fistulas. It is therefore a procedure of choice among sphincter-sparing techniques but at the price of a precise selection of patients…
My indications?
Fistulas with a direct route, long (≥50 mm) and narrow (in practice, we just pass the 9 fr probe, i.e. about 3 mm) with an internal orifice that is not too wide, i.e. we can suture without too much tension without a connected diverticulum of more than 5 mm for Crohn’s fistulas.
Note that in case of Crohn’s disease, if the fistula is well dried out, and if all the clinical and MRI inflammatory signals are green, I don’t have the impression that the results are less good than for crypto-glandular fistulas. I therefore tend to propose RF before simple removal when the fistula has the above characteristics.
Dr. Dominique Bouchard, MD Procotologist, Head of the Proctology Unit, Maison de Santé Protestante Bagatelle, Talence, France
I have been working with Rafaelo for four years. Minimally invasive, with few complications and highly effective – from my point of view a highly useful addition in the treatment of haemorrhoids of all stages.
Priv.-Doz. Dr. med. Robert Eisele, Doctor, specialist in general surgery, visceral surgeon, Oranienburg, Germany
Treating patients with third-degree haemorrhoids with little pain and under local anaesthetic in the daily practice routine – the Rafaelo procedure now offers the possibility of a safe and reliable method!
Dr. Christian Lorz, MVZ for Surgery and Orthopaedics, Vincentinum, Augsburg, Germany
I have good feedback with patients who have little or no pain and can return to work within 3 to 5 days.
Dr. Yann Redon, Visceral and digestive surgeon, Saint-Nazaire, France
The strengths of the Rafaelo procedure are, on the one hand, its very low morbidity, i.e. it is a low-pain technique in most cases, with the use of level 2 painkillers for two or three days, after which patients very quickly stop taking their painkillers. So the pain is usually very minor and quite short compared to the Milligan Morgan haemorrhoidectomy. The effectiveness seems to be true, both in the French evaluation and in my personal experience, as we have less than 5% surgical recurrence per year. The second aspect of this technique, which is also very, very interesting and puts it far ahead of the other minimally invasive techniques, is its simplicity and speed. Speed is really a big advantage of the technique because the administration of the product, let’s say, happens in two minutes, two and a half minutes, and the whole procedure takes a maximum of 10 minutes.
Dr. Dominique Bouchard, MD Proctologist , Maison de Santé Protestante Bagatelle, Talence, France
The Rafaelo technique completes the panel of operative techniques in relation to haemorrhoidal pathology. I think that we need to know them all, and have them all available. It’s a tool that we need at our disposal to be able to guarantee everyone the right treatment.
Dr. Antonella Liddo, Visceral and digestive surgeon, Hôpital de la Victoire, Tourcoing, France
At consultation, I was diagnosed with an anal fistula. I needed surgery. Of course (in anno 2023) hereafter you consult Dr Google to read all the horror stories about possible incontinence. A nightmare I didn’t want to experience. So I opted for Fistura, a muscle-sparing and safe method with maximum comfort for the patient. I was afraid I would experience some days of terrible pain, but nothing could be further from the truth! Extremely little pain and I was even allowed to go home the same day. Now, 6 months later, still no pain. Good luck Dr Google wasn’t right!
This minimally invasive treatment fills the gap between ligature treatment and surgical resection for haemorrhoidal disease. It is excellently suited to outpatient treatment in the proctological practice. I am particularly enthusiastic about the very low post-operative pain after Rafaelo therapy.
Dr. Daniel Sterzing, Specialist in general surgery, visceral surgeon, Proktologisches Zentrum Berlin, Germany
After being treated with Rafaelo, I have to say: I feel like a young deer on a sunny spring morning. After years, the misery has come to an end, thanks to Mr Vivaldi. My students would say: “He is a messenger of Allah! Thank you very much at this point. I will recommend with full conviction.
A German patient treated with the Rafaelo technique
Excellent workshop! well organised.
Participant (anonymous) Rafaelo workshop in Cologne