How should anal fistula be treated surgically?

Anal fistula, also known as anorectal fistula, is a relatively common rectal disease. Many people confuse it with hemorrhoids. The cause of anal fistula is generally the rupture of pus near the rectum, so patients must pay attention to anti-inflammatory and infection prevention when treating anal fistula. If the anal fistula is severe, surgery is often used as the treatment method. For example, incision and suture are common methods of surgical treatment of anal fistula. Surgical treatment can quickly reduce the impact of anal fistula on patients and reduce the threat to rectal health.

Surgical treatment:

1. Incision method:

Indications for the incision method: ① Anal fistula where the fistula passes through the subcutaneous layer and superficial layer of the external sphincter. ② Anal fistula: The fistula passes through the superficial and deep layers of the external sphincter. ③Anal fistula between the internal sphincter and the external sphincter. ④ The fistula passes through the anorectal ring, but its local lesion has been completely fibrotic, and scar adhesion has occurred with the surrounding tissues. ⑤ Anal fistula branches located in the subcutaneous ischiorectal space and post-anal space.

Incision principles: ① The incision part should not affect or basically not affect the anal sphincter function. ② If the anorectal ring is incised, the affected area must be completely fibrotic and have scar adhesions with the surrounding tissues. Anal incontinence should not occur after the incision. ③The incision should be located below the anorectal ring or at a location unrelated to the anorectal ring.

Incision method: Take the lateral decubitus or lithotomy position, disinfect the area, apply local anesthesia or sacral anesthesia, use a probe to find the internal opening, clearly explore the lesions in the pipeline, cut open the main and branch pipes one by one, scrape the rotten tissue, ligate the internal opening, smooth the wound surface, and fix it with Vaseline gauze, gauze, and adhesive tape, and take a warm water sitz bath every day. If the wound is not fresh, change the dressing with red powder gauze for the first two days, and then change to Yuhong ointment gauze until the wound heals. For low-position anal fistula, fistulotomy is less destructive, has smooth drainage, and is conducive to repair because the fistula only invades the superficial layer of the external sphincter and the subcutaneous layer. There is less scar tissue after healing, the surgical technique is simple, and the cure rate is high. For high anal fistula, since surgeons are often concerned about wound drainage, most incisions are large and most require cutting off the deep muscle fibers of the external sphincter. Therefore, a large number of patients have varying degrees of fecal and gas incontinence after surgery. Obviously, this treatment is not suitable for deep, high anal fistula.

2. Incision and suture method: This method is to completely remove the diseased tissue and then suture the wound. If handled properly, the effect is better. It is suitable for low-position simple anal fistulas with long tubes.

Incision and suture method: routine preparation before surgery, lateral position, after anesthesia, determine the position of the internal opening, insert the probe from the external opening and pass it out through the internal opening, use the probe to hook it out of the anus, and then cut the tube from the external opening to the internal opening along the probe, cut the entire tube, ligate the infected anal crypts on both sides of the internal opening, and completely remove the tube. Pay attention to removing all branches, stop bleeding before suturing, flush the wound and then suture in layers. The proximal end of the incision should be open to facilitate drainage.