TREATMENT OF ANAL FISTULA
treatment strategy consists of drainage of pus collections during acute stage (abscess)and eradication of all fistula tracts with
maximum preservation of sphincter muscles soon afterwardS
FISTULOTOMY WITH OR WITHOUT SPHINCTER REPAIR
fistulous tracts may be eradicated by excision or coring but this is rarely practised nowadays as laying open of tracts with curettage of blind tracts and cavities often achieve si
milar results with better preservation of continence laying open of fistulous tracts often means partial division of sphincter muscles division of any of the sphincters threatens continence however this is more so with the division of external sphincter and certain with division of the puborectalis .if a substantial part of the external sphincter is divided it is often advisable to combine this with partial sphincter repair (repair of the uppermost part of divided sphincter )after thorough curettage of the tract,s infected granulation tissue
OTHER METHODS
these include coring out the tract and closure of internal opening (simple closure or using mucosal advancement flap and or sphincter repair
SETONS a setons is a length of suture material (prolene ,nylon or rubber sling) used to traverse the fistulous tract . it may be used when fistula tract encircles more than 30% of sphincter complex or when local sepsis fibrosis preclude coring out,sphincter repair and raising of advancement flap
THERE ARE TWO TYPES OF SETONS
loose setons and tight setons .loose setons are used to drain pus or allow staged division of fistulas (LAYING OPEN THE LOWER HALF PASSING A SETON AROUND THE UPPER HALF AND DIVIDING IT AT A SECOND OPERATION AFTER HEALING OF THE LOWER HALF) .
tight setons are used to progressively cut through the sphincters .it is important when using a tight setons to lay open track outside sphincter ,divided the perineal skin overlying the encircled tissue as well as the internal sphincter so that the seton encircles mainly the external sphincter or part of it otherwise excessive fibrosis result .tightening setons is only started after sepsis has settled completely usually 3 week post operatively every 1-2 weeks
DRAINAGE OF POSTANAL ABSCESS AND HORSE SHOE FISTULA treatment is challenging
the traditional treatment of deep postanal abscess and the almost inevitable horse shoe extension has been laying open of the primary tract in the midline posteriorly ,as well as secondary horse shoe extension laterally .this result in a large gaping wound that need months to heal more often however the primary posterior mid line tract is laid open ,with coring out of other external openings and curettage of secondary tracts . this may be combined with drainage of individual secondary external opening .the latter approach markedly reduces healing time .alterntively an incision is made 2 cm posterior to the anal verge in the mid line and deepened to adequately deroof the postanal space . this is combined with enlarging the internal opening at the dentate line in the mid line posteriorly division of the internal sphincter and skin to the first incision and a tight seton is applied around the external sphincter to progressively divide it over the succeeding 3-4 weeks . this may be combined with separate stab incision to deroof lateral horse shoe extensions
tags:anal,fistulea,treatment
treatment strategy consists of drainage of pus collections during acute stage (abscess)and eradication of all fistula tracts with
maximum preservation of sphincter muscles soon afterwardS
FISTULOTOMY WITH OR WITHOUT SPHINCTER REPAIR
fistulous tracts may be eradicated by excision or coring but this is rarely practised nowadays as laying open of tracts with curettage of blind tracts and cavities often achieve si
milar results with better preservation of continence laying open of fistulous tracts often means partial division of sphincter muscles division of any of the sphincters threatens continence however this is more so with the division of external sphincter and certain with division of the puborectalis .if a substantial part of the external sphincter is divided it is often advisable to combine this with partial sphincter repair (repair of the uppermost part of divided sphincter )after thorough curettage of the tract,s infected granulation tissue
OTHER METHODS
these include coring out the tract and closure of internal opening (simple closure or using mucosal advancement flap and or sphincter repair
SETONS a setons is a length of suture material (prolene ,nylon or rubber sling) used to traverse the fistulous tract . it may be used when fistula tract encircles more than 30% of sphincter complex or when local sepsis fibrosis preclude coring out,sphincter repair and raising of advancement flap
THERE ARE TWO TYPES OF SETONS
loose setons and tight setons .loose setons are used to drain pus or allow staged division of fistulas (LAYING OPEN THE LOWER HALF PASSING A SETON AROUND THE UPPER HALF AND DIVIDING IT AT A SECOND OPERATION AFTER HEALING OF THE LOWER HALF) .
tight setons are used to progressively cut through the sphincters .it is important when using a tight setons to lay open track outside sphincter ,divided the perineal skin overlying the encircled tissue as well as the internal sphincter so that the seton encircles mainly the external sphincter or part of it otherwise excessive fibrosis result .tightening setons is only started after sepsis has settled completely usually 3 week post operatively every 1-2 weeks
DRAINAGE OF POSTANAL ABSCESS AND HORSE SHOE FISTULA treatment is challenging
the traditional treatment of deep postanal abscess and the almost inevitable horse shoe extension has been laying open of the primary tract in the midline posteriorly ,as well as secondary horse shoe extension laterally .this result in a large gaping wound that need months to heal more often however the primary posterior mid line tract is laid open ,with coring out of other external openings and curettage of secondary tracts . this may be combined with drainage of individual secondary external opening .the latter approach markedly reduces healing time .alterntively an incision is made 2 cm posterior to the anal verge in the mid line and deepened to adequately deroof the postanal space . this is combined with enlarging the internal opening at the dentate line in the mid line posteriorly division of the internal sphincter and skin to the first incision and a tight seton is applied around the external sphincter to progressively divide it over the succeeding 3-4 weeks . this may be combined with separate stab incision to deroof lateral horse shoe extensions
tags:anal,fistulea,treatment
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