rectal instruments


By • Дек 26th, 2010 • Category: Rectum

By far the most common type of ana! fistula are com­plete fistulas, that is, those with one or several external openings on the skin and one internal opening at one of the crypts of Morgangi. Incomplete internal fistulas, that is, those with a single internal opening into the rectal lumen are met wth only in 8 per cent of cases. In our experience of 6,000 operations, the internal fistulous open­ing was located in a posterior crypt in 55 per cent of pa­tients, in an anterior crypt in 35 per cent, and in a late­ral crypt in 10 per cent. The choice of operation will de­pend on whether the fistulous tract passes internally to the sphincter (Fig. 71) or skirts it outwardly (Fig. 72).

The operation for fistulas located internally to the sphincter, that is, laying open the fistula into the rectal lumen, has been known since Hippocrates. Under local anesthesia, a 1 per cent methylene blue is injected into the fistulous tract, followed by passage of a fine groo­ved director. The surgeon then divides the tissue bridge overlying the director (Fig. 73,1), curets the resulting wound with a sharp spoon, and ships off the both out­ward edges of the wound with scissors. (Fig. 73,2). The rectal lumen and the wound are packed with ointment strips as usual.

Varieties of fistula passing internally to the sphincter or through its fibers

Fig. 71 Varieties of fistula passing internally to the sphincter or through its fibers.

Fig. 72 Varieties of fistula passing externally to the sphincter.

Fig. 73 Laying the fistula open into the rectal lumen:

1. A tissue bridge over the director is dissected from the rectal lumen side.

2. The outer edges of the wound are cut off to pre­vent fistula recurrence

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