rectal instruments

AUTHOR’S VARIANT OF OPERATIONS FOR VERY LONG FISTULOUS TRACTS


By • Дек 26th, 2010 • Category: Anus

When an anal fistula is very long and its external opening lies on the buttock or near the trochanter we, rather than making large incisions, make use of our own procedure as shown in Fig. 80,1, 2 and 3. In this opera­tion, the fistulous tract is cut across 3—4 cm from the anus, and its proximal portion leading to the rectum is dissected free and sutured with catgut. These steps are preceded by introduction into the fistulous tract of methylene blue from the outside and, if possible, of a probepointed director, for this would make it easier to identi­fy the tract deep in the tissues. Next, a posterior sphinc-terotomy is performed (Fig. 80,4). The perineal wound is then packed with balsamic ointment (see page 40). The longer external portion of the fistulous tract which has been left intact will heal spontaneously. Opium tincture is given to the patient for 7—8 days. Dressings are ap­plied and the packs changed on the 3 and 5 days posto-peratively, and each day thereafter, following a bath.

Incision in a long fistulius tract which interrupts its communication with the rectal lumen

Fig. 80. 1. Incision in a long fistulius tract which inter­rupts its communication with the rectal lumen;

2. The Incision has been deepened and the fistulous tract into which a director probe or methylene blue has been introduced has been partially cut off.

3. Suturing the proximal portion of the fistulous tract.

4. Posterior sphincterotomy.



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