rectal instruments

OPERATIVE TREATMENT OF HORSESHOE (BILATERAL) FISTULAS


By • Дек 26th, 2010 • Category: Rectum

To cure this uncommon type of horseshoe fistula which lies on either side of the anus subcutaneously, we employ the bilateral fistulotomy according to Gabriel (Fig. 85,1).

In cases of high-level horseshoe fistula we first ex­cise the fisula on one side of the anus followed by sutur­ing its remnant on the wound bottom (see p. 82), and then from the opposite side (Fig. 85,2). The operation is completed by posterior sphincterotomy via the inter­nal fistulous opening (Fig. 85,3). In those cases of hor­seshoe fistula with the fistulous tract passing on the right side through the ischiorectal fossa, and on the left side subcutaneously (or the other way round), we perform fistulectomy with suture of the fistulous remnant о the wound bottom on the right side, followed by the di; section of the fisulous tract into the rectal lumen on th left side with suture of the wound bottom (see page 78 This procedure involves closure of the internal fistulot opening in the rectal lumen deep fithin the woun (Fig. 85,4); this opening is the internal opening for tr right-side fistulous tract as well. In cases with a neglei ted horseshoe fistula, we sometimes find it necessary 1 resort to the ligature method. In these operations, tl postoperative management is the same as that in compl cated fistulas.

Operations for horseshoe anal fistula

Fig. 85 Operations for horseshoe anal fistula:

1. Excision of a subcutaneous horseshoe fistula in the rectal lumen according to Gabriel.

2. Bilateral suture of the fistulous tract remnants the wounds.

3. Posterior sphincterotomy following suture of t fistulous remnants in the wounds.

4. Right: dissection of the fistula with closing t wound bottom. Left: closure of the fistulous remnant the wound.



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