rectal instruments

The operation for deep pelvirectal abscess

By • Дек 26th, 2010 • Category: Anus

Operation is performed under general anesthesia as in the preceding operation.

A linear incision of the skin and subcutaneous and is-chiorectal fat is made on the lesion side, the deep wound is drawn widely apart with retractors (Fig. 63.1). and fibers of the levator ani muscles visualized on the wound bottom are carefully dissected with a scalpel in an ante-roposterior direction (Fig. 63,2). The surgeon’s finger then penetrates into the abscess cavity to assess its size. The cavity is then washed with a 4 per cent hydrogen pyroxide solution and antibiotics, using a 10 ml syringe and a rubber tubing (Fig. 63,3). Often, to gain a wide access to the pelvirectal abscess cavity, the opening in the pelvic diaphragm has to be widened with the scalpel by moving its blade forward or backward. The operation is completed with posterior sphincterotomy (Fig. 63,4). Dressings are applied as indicated above; the rectum is packed with ointment packs for not more than 5 days, and the perineal wound for 15—17 days, after which time the deep cavity is washed with an antibiotic solution and then with 5 a per cent salt solution. The wound will heal within 30 to 40 days.

The operation lor retrorectal abscess is performed with the patient in a knee-elbow position under local anesthesia or in Depage’s position under inhalation ane­sthesia.

Depending on the site of the abscess a transverse in­cision is made posteriorly either to the left or to the right of the anococcygeal ligament (Fig. 64,1).

Following dissection of the skin the surgeon inserts his left index finger into the rectum, while the assistant draws the wound apart with retractors. Using his finger as a guide, the surgeon then cuts tissues down to the abscess keeping close to the surface of the coccyx (Fig. 64,2). After the pus has been evacuated the abscess cavity is washed with antibiotic solutions (Fig. 64, 3). To complete the operation, the abscess cavity is packed with Vishnevsky ointment эг with ointment in Peruvian balsam (Fig. 64,4).
Using this technique, a total of 1,200 operations for all types of acute anorectal abs­cesses have been performed with the cure rate of 92 per cent.

The steps in the operation for pelvirectal abscess

Fig. 63 The steps in the operation for pelvirectal abs­cess:

1. After the wound has been drawn apart with ret­ractors, fibtrs of the levator ani muscle can be seen in the depths of the wound.

2. Pelvic diaphragm is sagittally dissected with scal­pel.

3. The abscess cavity is washed with 4% hydrogen peroxide solution.

4. Posterior sphincterotomy 1 cm deep.

The steps in the operation for retrorectal abscess

Fig. 64 The steps in the operation for retrorectal abscess:

1. With the patient in a knee-elbow position, a trans­verse incision is made right or left of the anococcygeal ligament.

2. After it has been widenend with retractors the surgeon dissects the wound, using his finger as a guide.

3. The abscess cavity is washed with hydrogen pero­xide.

4. The wound is packed with Vishnevsky ointment. (Schematic).

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