rectal instruments

OPERATION FOR SUBCUTANEOUS FISTULA (after Gabriel)


By • Дек 26th, 2010 • Category: Anus

This operation essentially consists in laying open the fistula into the rectal lumen with removal of a flap of surrounding skin and mucosa. Under local anesthesia or general nitrous oxide anesthesia, a 1 per cent methylene blue solution is injected into the fistula followed by the passing of a fine grooved director, he surgeon then marks out a triangle- or oval-shaped flap of mucosa and skin subject to removal (Fig. 74,1). Next, the fistula is laid open into the rectal lumen over the director. The skin and mucosa flaps are dissected away superficially in the direction of the wound and removed (Fig. 74,2). Appearance of the superficial wound after a Gabriel ope­ration is depicted in Fig. 74,3. Dressings with ointment packs are applied as usual, 3 and 5 days postoperative-ly, and opium tincture is given for 4 or 5 days. This ope­ration is indicated irespective of the localization of the fistula, provided only that this passes internally to the sphincter or through its fibres (Fig. 74,3 and 4). The ope­ration is highly effective: of 1,900 patients operated on by us, 99.0 per cent have been cured.

Operation for subcutaneous fistuia according to Gabriel (dissection of fistula with removal of cutaneous mucous flap)

Fig. 74 Operation for subcutaneous fistuia according to Gabriel (dissection of fistula with removal of cutaneous mucous flap):

1. Laying the fistula open into the rectal lumen over the director.

2. Excision of skin and mucosa flaps previously mar­ked out.

3. and 4. Appearance of the wounds of perineum and anal canal mucosa following excision of subcutaneous-submucous fistula according to Gabriel



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