The initial reason for writing this article came from a patient I met recently. He was from Inner Mongolia, in his prime and in good health. He had already undergone two surgeries because of an anal fistula. When I examined him, I was shocked. The two surgeries had left huge wounds on his body and had caused extensive scarring. This led me to think about the principle that doctors need to follow in anorectal surgery: in addition to eradicating the lesion, they need to protect the tissues and muscles around the anus to the maximum extent possible and protect the body from being too affected in its function. Therefore, this time I would like to talk to you about whether a larger or smaller surgical incision is better! A large incision can completely remove the lesion. Perianal abscess is an infectious disease. The important criterion for this type of surgery is whether the drainage is clear. This directly determines whether the necrotic tissue left behind by deep infection can be drained out of the body as soon and completely as possible. To use an analogy, if there is something dirty in the river, when the river is wide and the current is fast, with the power of water, it can be washed away. If the drainage is poor and the pus and other infected materials are not all drained out of the body, the wound will not heal easily. Therefore, when doing this type of surgery, we advocate that it is helpful to make the wound as long and wide as possible for recovery. ”Thorough” is not the same as drastic, but refined. So, is it understood that the longer, larger and wider the incision, the easier it is to grow well? If the surgical incision is small, thin and short, is it difficult to heal? This is not the case. The medical profession advocates that the tissue and muscles around the anus should be protected as much as possible while dealing with the lesion accurately, and one does not want to be too drastic, but should be finely sculpted. It is like a piece of land with several tunnels made by rats. When catching the rats, you can look carefully and shave each tunnel so as to remove the lesion. At this time, the soil between the two tunnels should be intact and retained. The whole ground cannot be plowed. This crude method does not distinguish between good parts or necrotic tissue, which can be damaged. Therefore, the main indicator for judging the success of the procedure is to ensure that the incision size is appropriate, does not affect the function, and causes little damage to the patient when possible. Combination of multiple surgical procedures to develop the best plan To do fine surgery, we must learn to convert complex problems into simple ones and treat multiple lesions separately according to the situation. In clinical practice, a combination of multiple surgical procedures can be used to avoid damage to patients caused by a single procedure. In fact, ah, the surgery can be rich, such as incision, hanging wire, open drainage, open window drainage and so on, the doctor must be flexible and adaptable, according to the situation to choose a highly targeted program, and ultimately achieve victory! For example, to treat a large abscess cavity, you can use counter-oral drainage, also known as “open window drainage”, which is to open a small incision at the distal end of a large incision to form multiple incisions for drainage, so as to achieve unobstructed drainage and complete drainage of pus out of the body. If deep pus cavity is encountered, the “hose drainage” method can be used: the hose is placed deep into the pus cavity, so that the dirty stuff can flow out along the hose. Don’t underestimate this “hose”, it is also very useful in the process of changing medicine. You can use metronidazole or saline to flush down the hose and flush out the deeper dirt. It is only after it is flushed out that fresh flesh shoots start to grow inside and gradually heal. It is the doctor’s duty to specify the appropriate treatment plan for each condition. It is important to achieve the goal of eradication and ensure the cure rate, while minimizing the damage to the anus and preserving the sphincter. This is a double test of the doctor’s reserve of experience and responsibility.