rectal instruments

ATTENTION! A FREQUENT OPERATION LAYING OPEN THE FISTULA INTO RECTAL LUMEN WITH SUTURE OF THE WOUND BOTTOM First main operation. Rygick’s modification


By • Дек 26th, 2010 • Category: Anus

In those cases of the Gabriel operation for laying open the fistula when the surgeon has any doubt as to the subsequent function of the anal sphincter, we have sutured, beginning with 1953, the bottom and walls of the wound with catgut, leaving the skin margins unsu-tured. Figure 75.1 shows the surgeon inserting the needle into the wound wall some 1 cm from the skin margin, and passing it under the wound bottom to bring it out on the oposite side without suturing the skin. In all, we apply 3 to 5 such sutures. The skin wound is left open, though somewhat narrowed (Fig. 75,2). The sutures should be spaced. 1.0—1.5 cm apart and tied with three knots. Ointment packs are then applied as usual (Fig. 62,3), and opium tincture is given for 8—9 days.

We have performed performed a total of 1,700 such ope­rations, with a cure rate of 98.0 per cent.

A second variant of this operation is used in cases when a deep wound surrounded by scars remains follow­ing dissection of a straight fistula. In this operation (Figs 76,1, 76,2 and 76,3), the right-hand side of the wound is first sutured with the needle brought out on the wound bottom; the needle is then reinserted into the wound bottom to emerge on the opposite side of the wound, he skin is not sutured (Fig. 76,2). The sutures are praced 1 —1.5 cm apart and tied with three knots. Ointment packs are applied as usual (see Fig. 62,3), and opium tincture is given for 8—9 days.

Laying the fistula open into the rectal lumen with closure of the wound bottom

Fig. 75 Laying the fistula open into the rectal lumen with closure of the wound bottom:

1. Four catgut sutures have been placed on the bot­tom and wall of the wound while the rectal lumen was enlarged with speculum.

2. Catgut sutures have been tied and cut off. The sphincter is sutured, the wound is narrowed but is still open.

Fig. 76 Variant of second operation for deep fistulous tract:

1. Passing the suture through the right-hand wall of the wound; the suture is brought out through the wound bottom.

2. Passing the suture through the left-hand wall of the wound; the needle is reinserted into the wound bot­tom.

3. Appearance of the wound after the sutures have been tied.



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