Features of surgical tactics at the outer adrectal incomplete fistula
Science Articles / / April 24, 2016
Zhukov BN, Isaev VR, AI Savinkov, Chernov AA, Kudryashov SK, Polikashin NN
Department of Hospital Surgery SSMU, Samara
coloproctological The department of hospital surgery clinic SSMU in the period of 1997-2003.702 patients were treated with various embodiments adrectal fistula.Achieved 675 radical surgery (96%).In 307 patients with surgery performed excision of fistula in the rectum lumen suturing wounds on the bottom and surface intrasfinkternyh chressfinkternyh adrectal fistula.When ekstrasfinkternom and deep location chressfinkternogo fistulous performed 166 operations with plastic lateral displacement of the anal canal mucosa, 68 operations - with plastic mucosa movement of the rectum and a variety of sustainable drainage adrectal fiber, 39 operations - using ligature method.We identified 56 patients with incomplete internal fistulas adrectal.All patients with this form of fistula surgery performed by Gabriel with an additional curettage spoon Volkmann purulent cavity in the submucosal layer.
patients with incomplete external fistula ekstrasfinkternymi adrectal highlighted in a special group (55 patients, or 8.1%).Of this group, 16 patients were excluded from the temporarily incomplete external fistula adrectal when the internal opening of the fistula was found during surgery and perineal muscle relaxation by staining with methylene blue fistula with 3% hydrogen peroxide solution or on certain circumstantial evidence.In practice, to determine the temporarily closed internal opening of the fistula pay attention to the following features: 1) papillomatous growths, scar or scar thinning of the mucous membrane of the seal with the presence of retractions wash the affected anal crypts;2) hyperemia and edema in the area of the anal crypts, the definition of the most painful point;3) the penetration of the probe bellied up to the submucosal layer, limiting displaceability of the mucous membrane at this point;4) displacement of a limited portion of the mucosa while sipping for vypreparovanny pararectal fistula.
P richinoy true adrectal incomplete external fistula are perineal trauma with the introduction of foreign bodies in adrectal fiber, skin disease, and festering spontaneous dissection Presacral dermoid cysts, Bartholinitis, abscess of the prostate, atypically occurring paraproctitis (A.M.Aminev, 1973).A common feature of true incomplete external fistula adrectal area is the lack of communication with the lumen of the fistulous rectum.The use of modern diagnostic methods in the survey Proctologic patients, including fistulography, computed thermography, computed tomography allow correct diagnosis and perform radical surgery.
Depending on the identified reasons for the formation of incomplete external fistula pararectal in Coloproctology department were performed 39 operations;excision of the fistula and cyst Bartholin gland (9), excision of the fistula to the wall of the capsule of the prostate gland (6), excision of the fistulous with excision which revealed Presacral dermoid cysts (5), excision of a fistula with the removal of foreign bodies from adrectal fiber (5), dissection and excisionsinus tracts with pyoderma perineum, perianal region festering atheroma (14).When
revealed indirect signs of internal fistulous opening, that is, when temporarily incomplete external fistula adrectal performed radical surgery resection of the fistulous with the preventive detachment and displacement of the anal canal mucosa (16), excision of fistula ligature method (2).
Thus, you must keep in mind a number of diseases that can lead to the formation of true incomplete external fistula in adrectal areas not associated with the lumen of the rectum to avoid diagnostic errors and, as a consequence of inadequate surgical intervention in patients with this pathology.