Anal fistula is one of our common diseases in anorectology (three common diseases in anorectology: hemorrhoids, fistulas, and fissures). Anal fistula is an infected canal that connects the anal canal, rectum and perianal skin, often caused by perianal abscesses after incision or self-rupture, and can be recurrent and perennial. An anal fistula consists of three parts, namely the primary internal opening, the fistula tract and the secondary external opening.
Clinical manifestations.
1, Most patients have a history of perianal rectal abscess incision and drainage or self-rupture.
2. If the external fistula is temporarily closed, the symptoms of perianal rectal abscess such as local redness, swelling, heat and pain reappear and may break down again and flow pus.
3. There is often discharge from the external opening of the fistula, which can cause eczema and itching of the skin around the anus.
Common subtypes of anal fistula.
The principles of surgical treatment for anal fistula: accurate search for removal of the primary lesion (internal opening), unobstructed drainage, avoidance of damage to the deep sphincter, protection of anal function, and reduction of trauma.
According to the pathogenesis of anal fistula, the hospital adopts anal fistula incision and counter-oral drainage. The indications for surgery are mainly for those with long external orifices from the anus and those with multiple branches. The skin is preserved between the internal and external orifices to reduce trauma and drainage, reflecting the principle of minimally invasive surgery.
Anal fistula incision and counter-oral drainage.
1. choice of anesthesia: local anesthesia (10-20 ml of 0.66% lidocaine with 2 drops of epinephrine) is generally used, while lumbar anesthesia with low concentration of ropivacaine can be used for high anal fistulae
2.Operation methods.
1), probing the direction of the main canal, the condition of the branches, the relationship between the main and branch canals, and finding the location of the internal opening (infected anal sinus) under direct vision.
2), making a small incision along the external opening of the fistula slightly to make an oval excision so that the external opening is freshly wounded.
3), make an incision along the canal from between the anal verge and the internal orifice to remove the toothline infection focus (infected anal sinus) and the primary internal orifice.
4), retaining the skin and normal subcutaneous tissue above the external and internal anal trauma fistulae, separating the canal with curved forceps as appropriate, without using oil gauze strips and drainage tubes to penetrate and drain between the internal and external orifices.
5), branches can be cut or not cut.
6), methylene blue bureau seal for long-lasting pain relief.
7), electrocoagulation to stop bleeding, diclofenac sodium suppository 1 capsule nano-anal, gelatin sponge or Belling collagen sponge to fill the incision, external dressing wrapping fixed, no drainage tube placed.
3.Postoperative treatment.
1）.Do corresponding treatment according to the relevant anesthesia.
2）No need to fast, but avoid spicy and stimulating products.
3） Pay attention to the bleeding and urination on the postoperative day, and active bleeding should be treated promptly.
4）.Use discretionary laxative drugs: polyethylene glycol 4000 to prevent constipation and fecal impaction.
5), postoperative fumigation sitz bath: can clear heat and detoxify, astringent and swelling Chinese herbal fumigation, prescription: dandelion, purslane, alum, cypress, bitter ginseng, double flower, rhubarb, horsetail, ground elm, forsythia, etc..
6), during hospitalization, daily disinfection of wounds with iodophor, anal anal pain relief with diclofenac sodium suppositories (when necessary), topical application of compound comfrey oil for decay, muscle growth and pain relief.
7), discretionary antibiotic anti-infection treatment, anti-infection treatment with antibiotics (second generation cephalosporins) within 24 hours after surgery.
8), daily change of medication within 1 week after surgery, after which the interval of every 3-5 days to come to the hospital for a change of medication, between the self with a cotton swab dipped in iodine volt change.