Prof. Derek Fischer: Assistance with Anal Fistulas and Pilonidal Sinus
Prof. Dr. Derek Zieker-Fischer studied medicine at the University of Tübingen, completing semesters abroad in South Africa and Switzerland. After his studies, he initially worked as an assistant doctor and later as a specialist at the University Hospital Tübingen. During this time, he obtained his specialization in General and Visceral Surgery and completed his habilitation.
In 2014, he moved to a senior position at the DKD in Wiesbaden, where he enhanced his skills in colorectal surgery with the additional qualification of proctologist.
In 2016, he founded the Surgical Proctological Center Reutlingen. He has maintained his connection with the University of Tübingen through his teaching activities there.
Prof. Dr. Zieker-Fischer, the Surgical Proctological Center Reutlingen is a practice with a “well-defined surgical spectrum.” What does that mean?
The Surgical Proctological Center focuses on diseases of the intestine and rectal area. Preventive colonoscopies (examination of the colon and often the last part of the small intestine) are also performed here. Using the latest diagnostic and treatment methods, patient care is provided at the highest medical level and always at the forefront of science. The surgical-proctological center is a reference center in Germany for two leading medical technology companies.
What treatment methods are those?
The treatment methods depend on the patients' diseases. The symptoms presented by patients are as diverse as the underlying conditions. The therapeutic spectrum ranges from conservative therapies (non-surgical interventions) to various endoscopic and minimally invasive surgical procedures. Whenever possible, we treat on an outpatient basis and then according to the findings or at the patient's request under local anesthesia or general anesthesia.
What exactly are anal fistulas and how do they manifest?
Anal fistulas are inflammatory tissue changes that can run through, between, or outside the sphincter muscles. Symptomatic anal fistulas often present with the discharge of fluids at the anus and around the anus. An anal fistula is often preceded by an inflammatory change in the glands in the anal area, which can be perceived as an overheated swelling with purulent-bloody content. A persistent anal fistula showing the symptoms described above requires appropriate diagnosis and therapy.
What treatment options are available for anal fistulas?
The treatment of anal fistulas is individualized and depends on their course and complexity. Fistulas with only a direct tract and involving only a small part of the sphincter muscle or none at all can often be treated surgically [splitting and/or excision]. However, if the fistula involves larger parts of the sphincter muscle or branches out like a “fox den,” an individualized treatment plan should be developed for the affected patient. This is necessary because the sphincter apparatus varies between gender, age, pre-existing conditions, previous surgeries, and the location of the fistula. The highest priority, regardless of the surgical procedures selected, is always the preservation of fecal continence. A treatment method in the context of fistula surgery for higher-level (involving more sphincter muscle tissue) anal fistulas is the FiLaC method by biolitec. Here, a flexible, thin optical fiber is inserted into the fistula tract, and laser radiation is used to destroy the surrounding fistula tissue. The radiation intensity can be excellently regulated, ensuring that only the inflamed fistula tissue is destroyed. Furthermore, the internal fistula tract is then sealed. This type of operation is very sphincter-sparing, thus preventing incontinence caused by surgical therapy.
Are there other conditions that can be treated with the FiLaC method?
The FiLaC method can, in principle, be used wherever a combination of destruction of inflammatory tissue with simultaneous wound closure is desired. The FiLaC method can also be applied in the area of the gluteal cleft for pilonidal sinus or for recurrent abscesses in the context of the chronic inflammatory disease acne inversa (which often occurs in the area of the anus and genitals).
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