PD Dr. Jacob treats anal and pilonidal fistulas using laser therapy.

In Berlin, PD Dr. med. Dietmar Jacob practices at the multi-location surgical group Chirurgisch Orthopädischer PraxisVerbund (COPV) in Steglitz and Zehlendorf. In addition to conventional surgical procedures, the experienced general surgeon and proctologist focuses on minimally invasive techniques to provide patients with tissue-sparing and low-pain treatments. Maximizing patient comfort and achieving aesthetically pleasing results are also key priorities in the minimally invasive treatment of anal and pilonidal fistulas.

Dr. Jacob, how long have you been working with FiLaC® laser therapy?

I have been using FiLaC laser therapy for the treatment of anal and pilonidal fistulas since mid-2018, and I am very satisfied with this minimally invasive approach.

What are the advantages compared to conventional surgery?

In general, the treatment is associated with significantly less pain than conventional surgery. This is because it is a minimally invasive procedure that requires only a very small incision—or sometimes none at all.

Postoperative care and wound management are therefore much simpler. In traditional surgery, a relatively large wound area is often created, frequently accompanied by continuous wound secretion. In contrast, minimally invasive laser therapy enables a much faster recovery process.

Another major advantage of FiLaC® laser therapy is that the sphincter muscle is not compromised during the procedure, significantly reducing the risk of incontinence. This is a crucial factor for many patients when choosing a treatment option. In addition, the procedure can be performed on an outpatient basis by experienced surgeons and anesthesiologists, eliminating the need for hospitalization.

Diseases of the anorectal region are still a taboo topic for many people. Why is it important to see a doctor early?

Conditions detected at an early stage are generally much easier to treat than those that are already advanced. For this reason alone, early consultation is highly recommended.

Patients are advised to seek medical attention if symptoms persist for more than four weeks—these may include bleeding or persistent itching. Feelings of embarrassment should not be a barrier. Proctologists are specialized physicians who are very familiar with these conditions and understand the concerns and hesitations patients may have.

Is it important to consult a specialist?

Yes, absolutely. Patients should consult a proctologist. This specialist focuses on diseases of the rectum and can provide an accurate diagnosis and appropriate treatment after a thorough examination.

In rare cases, symptoms that are often dismissed as hemorrhoids may actually indicate a malignant condition that requires immediate clarification. Early assessment by a specialist is therefore essential.

Proctologists also ensure that patients have undergone important preventive screenings, such as colonoscopy (recommended for men from age 50 and women from age 55), and can provide referrals if needed.

What does the laser treatment process look like, and how long is the recovery?

In my opinion, procedures in the anal region should be performed under anesthesia. This allows the surgeon to thoroughly examine the anal canal, as the sphincter muscle relaxes under anesthesia—something that is often not possible otherwise. It also provides the flexibility to switch to alternative surgical techniques if medically necessary.

Patients are therefore always informed about multiple treatment options beforehand, as the exact course of the fistula can often only be fully assessed during surgery under anesthesia.

Postoperative care is very straightforward. Patients typically require little to no pain medication in the first three days. A small open wound remains at the site of the fistula, which may release a small amount of fluid over the following 2–4 weeks. A simple dressing or compress in the underwear is usually sufficient.

After about four weeks, the fistula is typically healed and closed, and no further aftercare is required.

The treatment of pilonidal fistulas follows a similar process. The procedure itself takes about 10 minutes under anesthesia. The fistula openings—usually more than one—may secrete some wound fluid for up to four weeks, after which healing is complete.

Book an appointment with Dr. Jacob.