How to treat anal fistula, surgical removal is the most effective

If anal fistula is not treated in time, it will cause chronic infection. The most common method for treating anal fistula is surgery, and fistulaotomy is also very common. The most important thing is the postoperative care for anal fistula. Patients with anal fistula should pay attention to their daily hygiene.

1. Fistulotomy

The fistula is completely opened. A method of wound healing that relies on the growth of granulation tissue. It is suitable for low-position anal fistula because the fistula is deep below the external sphincter. After the incision, only the subcutaneous and superficial parts of the external sphincter are damaged, and postoperative anal incontinence will not occur. The operation is performed under caudal anesthesia or local anesthesia. The patient is in the lateral decubitus or lithotomy position. First, methylene blue solution is injected from the external opening to determine the position of the internal opening, and then a probe is inserted into the gall duct from the external opening. Understand the course of the fistula and its relationship with the sphincter.

2. Surgical steps of anal fistula incision:

(1) Correctly explore the internal opening. The operation of finding the internal opening is the same as that of the hanging thread therapy. After finding the internal opening, pull the probe out of the anus. If the fistula is bent or has branches, the probe cannot be inserted into the internal opening. Inject a small amount of 1% methylene blue solution from the external opening to determine the location of the internal opening. Then use a slotted probe to explore from the external opening, gradually cut the tract, and explore until the internal opening is found. If the internal opening cannot be found after careful exploration, the anal sinus suspected of having a lesion can be treated as the internal opening.

(2) Open the fistula and fully remove the marginal tissue

After the fistula is opened, check for branches, and if found, they should be opened. After the fistula is completely incised, the rotten granulation tissue will be scraped clean. Generally, there is no need to remove the entire fistula to avoid excessive wound size. Finally, trim the wound edges to make it into a "V" shape with a small bottom and a large mouth, so that the deep part of the wound can heal first.

(3) Anal sphincter section

During the operation, the relationship between the position of the probe and the anorectal ring should be carefully understood. If the probe enters below the anorectal ring, although the fistula and most of the external sphincter and the corresponding internal sphincter are completely incised, anal incontinence will not occur because the puborectalis muscle is preserved. If the probe enters the rectum above the anorectal ring (such as suprasphincteric anal fistula and extrasphincteric anal fistula), fistula incision should not be performed, and thread hanging therapy or thread hanging staged surgery should be performed. In the first stage, the fistula tract below the ring is incised or removed, and the fistula tract above the ring is hung with a thick silk thread and tied tightly. The second stage of surgery is to wait until most of the external wounds have healed and the anorectal ring has been adhered and fixed, and then the anorectal ring is cut open along the hanging line. After the fistula is opened, the granulation tissue on the wall can be scraped off with a curette and generally does not need to be removed to reduce bleeding and avoid damaging the sphincter on the posterior wall. The excised fistula tissue should be sent for pathological examination.

3. Anal fistula care

1. Health education. Introduce the purpose and advantages of this operation to the patient and obtain the patient's understanding and cooperation. Guide patients to choose qualified sanitary napkin products. It is best to use products of the same brand and choose sanitary napkins with cotton surface to reduce friction between sanitary napkins and local skin and reduce discomfort.

2. Operation method. Use warm water to do a perineal wash or sitz bath, wipe the perineum dry, and keep the anal area dry and clean. After tearing off the central sticker on the sanitary napkin, stick it on your underwear with the front side facing up, with the center of the sanitary napkin pointing to the anus after putting on the underwear. This is a cleaning operation. Remember to wash your hands before and after changing the sanitary napkin.

3. Notes. If the patient is allergic to a sanitary napkin and it causes local skin discomfort, the patient should immediately switch to a different product. If the allergy is severe, the patient should stop using it immediately and take good care of the local skin. Sanitary napkins should be changed every 4 hours during daytime use and no more than 8 hours at night. They should be changed promptly when secretions are excessive.