rectal instruments

POSTOPERATIVE MANAGEMENT OF PATIENT


By • Дек 26th, 2010 • Category: For surgery

Ointment packing of wounds. We complete all rectal and perineal operations by applying ointment packs to the wounds, using gauze strips impregnated with the liquid balsamic ointment of Vishnevsky according to the formula: pitch 3g, xeroform, 3 g, anesthesia 1 g, and castor oil 100 ml. Good results are also produced by a Peruvian balsam ointment (Balsami Peru 20 g, Xerop-hormii 3 g, Anesthesini 2 g, and Olei Riclni 100 ml).

After the packs are introduced into the rectal lumen, we insert there a small-bore rubber tube to evacuate gases.

Management of patient after minor proctologic ope­rations. In the proctologic clinics headed by the author, a special system of postoperative management has been developed, which is based on the use of oil-balsamic pa­cking of wounds, rare dressings, and relatively pro­longed (4 to 10 and more days) confinement of bowels with the aid of oral administration of opium tincture. This system has fully justified itself in more than 15,000 operations on the rectum.

The first dressing with renewal of the packs is usu­ally done three days after the operation, only outer dressings being changed on the second day. All dres­sings should be applied after a total-body bath (at 35— 36°C for 10—12 minutes). Females with rectovaginal and anterior rectal fistulas should not have a bath until the 7th or 8th postoperative day.

After an operation for hemorrhoids or anal fissure it is best to apply the first dressing under a short genera or local anesthesia with injection of 10—15 ml of 0.1 per cent novocain solution from 4 symmetrical point arround the anal orifice (see Fig. 28,3). During dressing the rubber tube and packs are carefully removed fror the perineal and rectal wounds, with continuous irriga tion of the packs by a 4 per cent hydrogen peroxide so lution by means of a syringe.

After withdrawal of the packs the wounds are washei with a spray of antibiotic solution to be again fille with ointment packs. As a rule the packs are left in th rectal wound for not mere than 5 days postoperative!} Confinement of bowels is brought about by means с opium tincture (6 to 7 drops three times daily befor meals).

In fissures, fistulas, hemorrhoids, and anal polypi the bowels should be confined for 4 to 6 days; in pile nidal sinuses and complicated anal fistulas for 7— days; and in rectovaginal fistulas and malformations с the perineum, for 10—12 days.

We know from our experience that when opium tint ture is used, the bowels may well be confined for 12 f 13 days, and this permits to dispense with a preternati ral anus in operations for sphincteric weakness, malfoi mation of the perineum, and in some other cases.

In patients with chronic colitis and in pregnant we men, 0.5 g of sulfaquanidine or norsulfazole powder are given 4 times daily in place of opium tincture.

Ointment packing of the terminal rectum with insertion of rubber tubing to evacuate gases

Fig. 34. Ointment packing of the terminal rectum with inser­tion of rubber tubing to evacuate gases



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