rectal instruments

OPERATIONS FOR ANAL FISSURES


By • Дек 26th, 2010 • Category: Anus

In 90 per cent of cases anal fissures localize on the posterior coccygeal wall of the anal canal, and in 10 per cent on its anterior wall. No fissures are formed on the lateral walls of the anal canal. Multiple fissures are ne­ver encountered.

Operation for fissure excision with partial division of the sphincter. Under local or general nitrous oxide—oxy­gen anesthesia, a recta speculum is inserted into the rectal lumen (Fig. 107,1) and the fissure is circumscribed with an oval or triangular incision through the mucosa and adjacent skin. The mucosal flap is excised with scissors together with the fissure (Fig. 107,2). Sphincte-ric fibers in the wound ?re divided along the midline (Fig. 107,3) for a distance of 1 cm in males and 0.7 cm in females. Strong diet durirg 10 days al’ter operation to prefer the diarrhea!)

The rectal wound should never be sutured. The rec­tal lumen is packed with ointment and a rubber tube is inserted. Opium tincture is given for 5 days. The first dressing with removal of the packs is applied under ge­neral anesthesia 3 days following the operation. Packing is discontinued on the third day in females and on the fifth day in males, postoperatively. Beginning with the sixth day daily external dressings and daily baths are undertaken.

Operation for anterior anal fissure. In males, this operation is similar to that for posterior fissure, except that all maneuvers are made on’ the anterior rectal wall. In females the anterior fissure is excised superficially (Figs 108,1 and 108,2), while sphincterotomy is per­formed along the posterior rectal wall to a depth of 0.8 cm (Fig. 108,3). The rectal lumen is packed with ointment as usual, but in females the wound should not be packed for more than 3 days. The posterior sphincte­rotomy is done is these cases in order to temporarily re­duce sphincteric function.

The treatment of anal fissure by stretching the sphin­cter is less effective than surgery. This is an outpatient procedure performed as depicted in Fig. 101,1 and 101,2. After the sphincter is stretched, an ointment pack is introduced into the rectum and left there for 2 days. Bed rest and opium tincture are required for three days.

Operation for fissure excision with division of the subcutaneous portion of the sphincter

Fig. 107. Operation for fissure excision with division of the subcutaneous portion of the sphincter:

1. The fissure is exposed by means of rectal specu­lum.

2. Excision of the fissure together with an oval flap of mucosa and perineal skin.

3. Partial division of the sphincter for a distance of 1 cm in males and 0.7 cm in females.

Operation for anterior anal fissure

Fig. 108. Operation for anterior anal fissure:

1. The anterior wall of the anal canal is exposed with rectal specuturn whose handle is slightly turned for wards.

2. Exsicion of a fissure on the anterior wall with scal­pel and long scissors.

3. Division of the sphincter along the posterior wall of the anal canal for a depth of 1 cm.



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