rectal instruments


By • Дек 21st, 2010 • Category: Anus

Essentially, this operation consists of resecting that scar-changed part of the sphincter which is fused with the surrounding fibrous tissues, and in uniting the free muscular ends of the sphincter by means of sutures. The operation is performed either on the posterior, lateral, or anterior sphinctenc segments, depending on the lesion site (former trauma, operation involving incision of the sphincter, etc.).

Under local or combined inhalation anesthesia, an in­cision is made along the posterior semicircumference of the rectum (see Fig. 133,1), and a semicircular skin flap is dissected off toward the anal canal; the posterior seg­ment of the scar-changed anal mucosa is then care­fully dissected off with a sharp scalpel to a depth of 2 cm, under the guidance of the finger introduced into the rectum. This segment is next elevated with Farabef retractor and a cord-like or flattened portion of the sphincter if dissected free circumferentially, brought to the outside with Allis forceps and cut off on both sides (Fig. 134,1).

The free ends of the sphincter are carefully picked up with Allis forceps and drawn apart. The scar, tissue is then sutured together with the levatores in the wound depths with 3 or 4 fine catgut sutures (Fig. 134,2). The sphincter ends should now be brought together and sutu­red with a single horseshoe transverse suture of fine silk from below and with two longitudinal sutures from abo­ve (Fig. 134,3). The skin flap is then shortened some­what, and sutured to its proper place (Fig. 134,4) leaving a thin rubber tube to protrude from the wound.

The patient is given opium tincture for 7 days. Dress­ings of gauze strips soaked in 40 per cent alcohol be changed daily.

Resection of the part of the sphincter with suturing of its ends

Fig. 134. Resection of the part of the sphincter with sutur­ing of its ends.

1. The separated scar-changed portion of the sphinc­ter is pulled out with forceps and cut off on both sides.

2. Scar tissue together with the levatores is sutured with fine catgut in the wound depths.

3. Free ends of the sphincter are sutured with horse­shoe and transverse silk stitches.

4. The truncated mucocutaneous flap is sutured in place leaving a thin drain.

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