Laser Therapy Effective in Treating Perianal Fistulas

Laser Therapy Effective in Treating Perianal Fistulas

By Dr. Ed Mapes
Stonebridge Animal Hospital
McKinney, Tx

Perianal Fistula is a chronic disease that can occur in any breed of dog but is seen most commonly in German Shepherds. Patients develop painful draining tracts that erupt through the skin in the region surrounding the anus. This condition is often not noticed by pet owners in early stages, but clinical symptoms become obvious as the lesions progress.

Dogs usually begin licking at the area, often incessantly, which only causes more inflammation. Pus and a bloody discharge will exude from the tracts, which take on an offensive odor. Dogs often begin to eat less, strain to defecate, lose weight, become withdrawn or even aggressive as the discomfort becomes more intense.

Current thought is that immune hypersensitivity may be a component of this disease, linking it to inflammatory bowel disease that is sometimes seen in these patients as well.

We first noticed the signs of fistulous development in Ellie when prepping her for spay at the age of six months. Several small tracts were present though she’d shown no symptoms of discomfort at that time.

The latest recommendations for medical treatment of perianal fistulas are a combination of immunosuppressive drugs along with a hypoallergenic diet. We used cyclosporine and ketoconazole to counteract the abnormal immune response that causes the fistulas. A hydrolyzed diet used to treat food allergy and inflammatory bowel disease (Hill’s HA) was also begun.

Several days after beginning this regimen, Ellie presented with a 3 cm swelling in the right perianal region that appeared to be severe inflammation of the anal sac. We treated with one laser therapy session and continued the current medications.

Recheck of the swelling on the following day showed 100% remission of the enlarged tissue. Medications were continued while monitoring Ellie’s progress. The fistulas receded slowly and became less painful. Ketoconazole and antibiotics were discontinued after 4 weeks while cyclosporine was continued for another month.

After 12 weeks of cyclosporine administration, the fistulous lesions appeared to be controlled and we discontinued cyclosporine at that time. Ellie did well for six weeks, but did develop several small lesions as the disease process apparently recurred. At this point we performed a laser therapy of the region, and then repeated in two days at which time the area was entirely clear of lesions. Seven weeks have now passed without recurrence.

We will continue to monitor the area closely and intend to continue episodic laser therapy if lesions reappear. It seems apparent that the anti-inflammatory properties of laser therapy are beneficial in controlling this condition. We will incorporate laser therapy into our protocols for treating this disease not only because of its apparent efficacy, but due to the expense of cyclosporine and other immunomodulating drugs.

The laser will be used alongside cyclosporine and ketoconazole initially. If remission comes about more quickly, the drugs will be discontinued earlier and we will attempt to maintain remission with laser therapy only.

This is an exciting development and may be a harbinger of faster and more cost effective therapy for this troublesome disease.

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