Complex subcutaneous fistula incision or resection

Complex subcutaneous fistula incision or resection is one of the surgical treatments for subcutaneous fistula dysfunction. Currently mainly used to treat anal fistula. Treatment of diseases: anal fistula Indication 1. Non-surgical treatment of low-grade subcutaneous fistula that does not heal for 3 months. 2. Tuberculous subcutaneous fistula, no systemic active tuberculosis. Contraindications 1, with systemic diseases, can not tolerate surgery. 2, local infection, not suitable for surgery. Preoperative preparation Antibiotics are routinely used before surgery. Surgical procedure If there are more than one external or internal mouth, you can first insert gauze into the anal canal, and inject the blue from the earliest appearance in the medical history to observe the position of each internal mouth. Probes were used to probe the earliest fistula, cut and removed in a single piece, and then the outer or inner mouth of each branch was examined one by one, and all of them could be cut, but not necessarily all, resulting in postoperative scar stenosis. If some fistulas are located above the shallow group of the anal sphincter, or if there are multiple internal mouths, they should not be cut temporarily. First, use black thick thread to pass through these fistulas, loosening and knotting one by one for the mark, after the shallow wound is healed, After the operation, the deep fistula was opened one by one. This method can avoid the incontinence caused by cutting all the deep and shallow anal sphincters at the same time or cutting two or more anal sphincters at one time. complication Bleeding Not much. Often due to vascular retraction and not timely ligature. It can be temporarily filled with gauze and pressure-wrapped. If the bleeding still does not stop, surgery must be stopped. 2. Anal incontinence Although rare, it is a serious complication. Mostly because the anorectal ring is cut off, or partially cut off, and the anus is completely incontinent or partially incontinent. 3. Anal scar contracture deformation Mainly due to the large and deep anal fistula wounds, the resection of the anal margin tissue is too much, the wound edge collapses, and the scar shrinks after healing. Secondly, after cutting the anal ligament or removing the tailbone during surgery, the anus is displaced forward, changing the angle between the rectum and the anal canal. 4. Wound growth is slow If the anal fistula is large and deep, slow growth is normal. If the growth is too slow, consider the following factors: 1 patients have other diseases, such as diabetes, tuberculosis, etc.; 2 foreign bodies in the wound, such as silk, dressings, fish bones, etc.; 3 improper dressing, treatment is not timely, causing wound adhesion and False road formation, and even wound infection. 5. Rectal mucosal prolapse Often accompanied by anal incontinence, the two causes the same reason, if necessary, must be treated at the same time. 6. Urinary retention In addition to its own genitourinary system disorders, reactive urinary retention is mainly caused by pain. Anal canal nerves are closely related to the bladder and neck nerves. Anal stimulation can often cause posterior urethra and bladder neck spasm, especially in cases where anal canal is placed. As long as the cause of pain is removed, sedatives can often be administered to urinate. If you still can't urinate, you can give 0.25mg of carbachol subcutaneously. Those who still can not urinate 12 hours after surgery should be catheterized.