One-stage suture of anal fistula excision wound

One-stage suture for anal fistula resection is used for the surgical treatment of anal fistula. Anal fistula mainly invades the anal canal, rarely involves the rectum, and is an infectious duct that communicates with the perianal skin. The inner mouth is located near the tooth line, and the outer mouth is located on the perianal skin. It is a common disease in anal canal and rectal diseases. There are many classification methods for anal fistula, but it is not only related to the location of the abscess around the anorectal rectum, the relationship between the fistula and the anal sphincter. At present, the anal fistula is divided into four categories according to the relationship between the fistula and the sphincter. 1 sphincter anal fistula: mostly low anal fistula, the most common, accounting for about 70%, is the consequence of abscess around the anal canal. The fistula only passes through the internal sphincter, and there is usually only one outer mouth, which is closer to the anal margin, about 3 to 5 cm. A small number of fistulas are up, forming a blind end between the rectal ring muscle and the longitudinal muscles or penetrating into the rectum to form a high sphincter spasm. 2 sphincter anal fistula: can be low or high anal fistula, accounting for about 25%, is the consequence of the ischial rectal abscess. The fistula passes through the internal sphincter, between the superficial and deep parts of the external sphincter, and there are often several external ports, and the branches communicate with each other. The outer mouth is closer to the anal margin, about 5cm, and a few fistulas pass up through the levator ani muscle to the connective tissue adjacent to the rectum, forming a pelvic rectal fistula. 3 sphincter anal fistula: high anal fistula, rare, accounting for 5%. The fistula passes up the levator ani muscle and then penetrates the skin down to the ischial rectal fossa. Because the fistula often involves the anorectal ring, it is difficult to treat and requires staged surgery. 4 sphincter anal fistula: the least seen, accounting for 1%, for the consequences of pelvic rectal abscess combined with sciatic rectal abscess. The fistula communicates with the rectum through the levator ani muscle. This anal fistula is often caused by Crohn's disease, colon cancer or trauma, and treatment should pay attention to its primary lesion. The above classification is more detailed in the high and low positions, which is conducive to the choice of surgical methods. Clinically, the anal fistula is often divided into two categories: low or high. The former is below the anorectal ring and the latter is above the anorectal ring. There are also an anal fistula from the shape of the fistula, which is divided into straight, curved and hoof-shaped anus. Straight sputum is often a low anal fistula, and the hoof-shaped anal fistula is often high, and the flexion can be low or high. From the pathological changes, it can be divided into suppurative anal fistula and anal fistula caused by specific infection. Anal fistula can not heal itself and must be treated surgically. The principle of surgical treatment is to cut all the fistulas and, if necessary, remove the scar tissue around the fistula, and gradually heal the wound from the base. Treatment of diseases: anal fistula Indication One-stage suture for anal fistula resection is applicable to: 1. The duct is more fibrotic than the simple and complex anal fistula, and the direction of the pipeline is below the anorectal ring. 2. Cooperate with hanging line therapy to treat high anal fistula. Preoperative preparation 1. Oral intestinal antibacterial drugs 1d, such as sulfaguanidine, neomycin, succinyl sulfonamide and the like. 2. Shave the skin around the anus. 3. Give fluid to the body 1d before surgery. 4. If necessary, do soapy water enema 4 to 6 hours before surgery. Surgical procedure 1. According to the principle of low straight anal fistula, the fistula is completely removed, leaving fresh wounds. 2. In the wound, the sphincter and fat layer were sutured several times intermittently with the gut. The surface of the anal canal was sutured intermittently with a thin line of the intestine. The skin was sutured with a fine non-absorbable line or a vertical suture. complication Wound infection is the main complication. The prevention method is strict surgical indications, and the preoperative preparation should be sufficient. All the internal and fistula tissues should be removed during the operation. The layers should be aligned when suturing, leaving no dead space. If the wound is infected, it should be opened immediately.