Anal fistula surgery, timely surgery is very important

Purulence caused by anal fistula is the most typical and also the most painful for patients. It requires surgical treatment as soon as possible. Common surgical methods include excision therapy and thread hanging therapy. The specific treatment method can be performed under the guidance of a doctor after detailed examination, and good care should be provided after surgery.

1. Resection therapy

1. Indications: Low-position anal fistula.

2. Contraindications: Fistula history less than 3 months; fistula with pus formation; severe pulmonary tuberculosis and other serious systemic diseases.

3. Operation method: Take the lithotomy position or lateral decubitus position for routine disinfection. Under lumbar anesthesia or local infiltration anesthesia, first insert a piece of saline gauze into the anus, and then use a syringe to inject 1% methylene blue from the outer opening of the leakage tube. If the gauze is stained with color, it will help to find the inner opening. Use a ball-tipped probe to probe from the external opening, and at the same time use the index finger of the other hand to insert into the anus as a guide. Carefully insert the probe from the internal opening, lift both ends of the probe, and use scissors to cut off the wall of the fistula and the surrounding scar tissue to form a wide wound with a small bottom. Fill the wound with Vaseline gauze.

4. Precautions: The direction of the leakage tube should be carefully checked before surgery, and only when it is confirmed to be a low-position anal fistula can a one-time resection therapy be performed. During surgery, the primary internal opening should be carefully explored to avoid excessive force, which may form a false internal opening and lead to recurrence of leakage after surgery. Change the dressing once a day after surgery to allow granulation tissue to gradually grow from the base and prevent bridge-shaped healing.

(ii) Incision plus hanging thread therapy

Incision and hanging thread therapy is a commonly used surgical method for high anal fistula. This method has the advantages of being simple, economical, not affecting anal function, and causing small scars. The mechanism is to cut open part of the tissue around the leaking tube and then use the mechanical action of the ligature to block the blood supply to the local tissue through the pressure or contraction force generated by the tight binding, causing ischemic necrosis. The incision is made slowly to allow the broken ends to have a chance to produce non-inflammatory adhesions with the surrounding tissues, thereby preventing the anal canal rectal ring from suddenly breaking and retracting and causing anal incontinence. Currently, rubber bands are often used instead of silk threads to shorten the treatment period and reduce postoperative pain.

1. Indications: High anal fistula.

2. Contraindications are the same as those for resection therapy.

3. Operation method: The patient takes the lateral position, local disinfection, lumbar acupoint anesthesia or local anesthesia, first tie a rubber band on the tail end of the ball-headed silver probe, and then gently insert the probe head from the outer opening of the leakage tube. At the same time, use the index finger of the other hand to reach into the anus to feel for the probe head, and then insert it from the inner opening. Lift both ends of the probe, and cut the skin and subcutaneous tissue between the inner and outer openings. The incision extends from slightly below the tooth line to the outer opening. Pull the probe out of the tube completely, pass the rubber band through the tube, lift both ends of the rubber band and tighten them, tie the two ends of the rubber band with silk thread close to the edge of the incision, and then cut off the excess rubber band two cm outside the ligature. Fill the wound with Vaseline gauze and cover with dressing.

4. Precautions: Keep bowel movements smooth after surgery, and take a sitz bath with 1/5000 potassium permanganate solution after defecation every day before changing the dressing. After the operation, tighten the rubber band and re-ligate it every 2-3 days. Generally, the leaking pipe will be disconnected in about 7-10 days. Postoperative dressing changes should be done carefully and seriously to ensure that the wound grows from the base to prevent bridge-shaped healing.