rectal instruments

OPERATIVE TREATMENT OF RECTOVAGINAL FISTULAS


By • Дек 26th, 2010 • Category: Rectum

These fistulas occur either as a result of an anorectal abscess which ruptures into the vagina, or are due to an accidental trauma (Fig. 86,1).

Under local or, more frequently, general anesthesia, the labia minora are fixed with suture out wardly and the rectovaginal septum is widely split transversely, ke­eping closely to the vagina. The surgeon’s fore finger introduced into the rectum prevents it from being inju­red. Deep in the wound, the fistulous tract is then divi­ded transversely (Fig. 86,2), and its opening leading to
the rectum is closed with two layers of catgut so that the upper row includes the edges of the levator ani muscles (Fig. 86,3). The fistulous opening on the vaginal wall is denuded and sutured with catgut from the wound side (Fig. 86,4). A speculum is now introduced into the rectum, and mucosa is freed on the anterior rectal wall as described on p. 88. This area and the fistulous open­ing are then sutured with 3 or 4 catgut stitches (Fig. 86,5), followed by posterior sphlncterotomy to a depth of 0.7—0.8 cm.

То complete the operation, the wound of the anterior perineum is closed in layers following introduction of po-lyvinyl tubes through the wound angles (Fig. 86,6). The patient is given opium tincture during 12 days. Full bed rest is necessary for 14 days. Urine is put out by the ca­theter 3 times a day during changing of dry dressings.

Operative treatment of rectovaginal fistulas resulting from obstetric or accidental traumas. Small-diameter fis­tulas should be operated on using the technique of peri­neum splitting (see Figs 86,3) and 86,4). The wound may be deepened almost as far as the posterior vaginal fornix, which can be facilitated by injecting a 0.25 per cent novocain solution into the septum. The rectal opening is closed with two rows of catgut. The vaginal opening is ale sutured with catgut from the vagina. Ex­tensive traumatic fistulas should be operated on from the vaginal side. The vagina is freed clean of the anterior rectal wall with a sharp scalpel (Fig. 87,1), and the rec­tal wall defect closed with two layers of catgut (Fig. 87,2). This is followed bp placing sutures on the vagina and performing posterior sphincterotomy to a depth of 0.8 cm (see Fig. 80,3)

Operations for rectovaginal fistula

Suture of the vagina wall in two layers

Fig. 86. Operations for rectovaginal fistula:

1. Rectovaginal fistula resulting from acute anorectal abscess.

2. Transverse incision of the anterior perineum. The tract of rectovaginal fistula has been divided.

3. Anterior rectal wall is closed in two layers together with the fistulous opening.

4. Vaginal wall opening is denuded and closed with catgut.

5. Anterior rectal wall and fistulous opening are clo­sed with catgut.

6. Appearance of the wound after suture of the skin.

Fig. 87.

1. Suture of the vagina wall in two layers.

2. Separation of the vagina from the rectal wall.

3. Suture of the rectal wall defect in two layers.



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