Medical services

Rectal fistula excision

Excision of rectal fistula is the only effective format of assistance to victims of such a serious illness. No alternative treatment can provide an equally high guarantee of the effectiveness of a positive result. This is confirmed by reviews of patients who pulled to the last, trying to help themselves by attracting folk remedies. Doctors insist that with a confirmed diagnosis it is impossible to delay for a long time with the neutralization of the fistula, as it quickly grows in size. The larger the diameter, the more difficult the operation will be. You will also have to accept the fact that the recovery will take a rather long period.

Fistula with localization in the rectum is a hole in the intestinal wall. It continues to move in soft tissues, ending with an exit out. Often the outlet is in the skin of the perineum, which adds inconvenience to the victim.

The main difficulty for the victim of such education is the passage of fecal contents into the fistulous path. The larger the diameter of the problem hole, the more intense the patient's waste products will flow through it, irritating the surrounding tissues.

Fistula classification

Before you send the ward to do the excision, the doctor must understand what kind of fistula format takes place in each particular case. This will allow to choose the optimal type of care, as well as speed up the postoperative period in the future.

According to statistics, anal fistulas account for about a quarter of all proctological diseases. Most of the formations of this kind are a logical consequence of the flow of acute paraproctitis. Due to the fact that a third of patients with these ailments do not seek help from a doctor on time, their medical history ends with various complications, including the formation of through holes or even death.

When the abscess enters the acute stage, it will open up on its own without surgical intervention, damaging the integrity of the peri-rectal tissue. But just in this situation a person will become a victim of an external fistula or its other variety.

Sometimes patients are asked to do without radical methods, preferring alternative intervention. It provides only the opening of the abscess itself, in order to release the accumulated dangerous contents of the "purulent sac". But this approach does not provide for the neutralization of the purulent course itself, due to which the risk of relapse rises to 50%. This means that the wound after the first opening will be a good environment for the re-accumulation of the contents threatening healthy tissues.

Even a complete laser excision does not always give a one hundred percent guarantee of a successful outcome. So, about 10% of all clinical cases of successful disposal of the primary fistula threatens to transform into a chronic form of the disease. In order to reduce the percentage likelihood of such a serious complication, physicians recommend immediately recording a consultation with a proctologist when they have profiled symptoms in themselves.

A little less provocateurs for growth of the hole are the following pathologies:

  • chronic ulcerative colitis;
  • rectal cancer;
  • Crohn's disease.

For ease of diagnosis, experts have formed their own fistulous classification.

It relies on the following types of specified anomalies:

  1. Complete It includes two holes that are localized in the intestinal wall and on the skin.
  2. Incomplete. It has only one outlet: internal or external.
  3. Simple. Provides only a single move.
  4. Complex. It is based on several moves, which include many branches.

The price of the treatment depends on which version of the diagnosis was found in the victim. Also, pricing policy can affect the format of the hole, which is based on the location in relation to the sphincter.

There are three categories in total:

  • Intrasphincteric, which intersects only part of the fibers of the outer part of the organ;
  • transsphytic, which crosses the entire sphincter;
  • extrasphinocular, which passes outside the sphincter.

The latter class is usually based so high that it provokes the formation of complex multi-way fistulas. To fight against them is the hardest.

Tactical decision

Virtually every private hospital offers several versions of therapy, depending on several factors, ranging from the financial ability of the patient, to specific medical indications.

If, even after setting the final diagnosis, to continue to try to help yourself, then this will only aggravate the clinical picture, worsening the general state of health. Since the lumps in the lumen come out regularly, it constantly infects the surrounding unprotected soft tissue. Because of this, the inflammatory process moves to the chronic phase.

In addition to feces through the hole secreted mucus, pus, ichor. All together, this is a great inconvenience for the patient, forcing him to use sanitary pads. An additional complication is the unpleasant smell that confuses the victim, forcing him to restrict his social life.

After a while, while ignoring the alarming symptoms, a person will definitely be faced with a weakened immunity, which will become a green light for the entry of other infections.

So one fistula causes:

  • proctitis;
  • proctosigmoiditis;
  • colpitis, which is characteristic of women with affected genitals.

Prolonged failure to provide assistance acts as a guarantor of the formation of a sphincter of scar tissue instead of normal fibers. Not only does such a scar ache, it also leads to the failure of the anal press. This is included in the sphincter "habit", and the person ceases to control not only the output of gases, but also feces.

Against the background of the above, the patient regularly records an exacerbation of chronic paraproctitis, which brings with it severe pain, fever, signs of intoxication, and body temperature rises. With such a development scenario, only an emergency operation will help.

The devil-may-care attitude towards one's own health is completed by the fact that the disease smoothly flows into a malignant oncologic neoplasm with rapidly spreading metastasis.

Here one cannot hope that everything will pass by itself. Chronic fistula is characterized by a tissue cavity, which is “supported” from all sides by scars. To get rid of it, you must remove the problem layer to a healthy tissue. Help in this can only laser excision or a similar variant of the cut of the lesion.

Preparatory stage

In order for the procedure to be successful, the patient will need to strictly follow the instructions for proper preparation. Since such intervention is called planned, everyone will have time to prepare for it.

Usually, with extensive lesions, the proctologist insists on immediately opening an abscess, cleaning the purulent cavity. Only after the success of the first stage is allowed to proceed to neutralize the passage itself. Usually between the stages takes about one and a half weeks. The exact term will be announced by the surgeon, based on the individual dynamics of the ward’s recovery.

A few days before the appointed date, the specialist will send the person who requested help to:

  • rectoromanoscopy, which helps to assess the internal state of the tissues;
  • fistulography, which covers the radiopaque study;
  • ultrasound procedure;
  • computed tomography of the pelvic organs to assess the condition of the adjacent internal organs.

Not without a standard test package, which includes a blood test, urine, biochemistry, electrocardiogram, fluorography, the conclusion of a gynecologist, a therapist. Separately, a preliminary allergic test is carried out, which allows you to block the risks of anaphylactic shock due to intolerance to the components of anesthesia.

Particularly noteworthy patients who have a number of chronic ailments. They will first have to consult with narrow-profile doctors, who must review the current approved treatment program to eliminate the conflict of medicines.

But it is strictly forbidden to change or interrupt the prescribed medication regimen. It is likely that the attending physician will recommend to wait a few weeks until the course is completed, and then proceed to surgery. The rule applies to those who suffer:

  • heart failure;
  • hypertension;
  • respiratory dysfunction;
  • diabetes mellitus.

If the situation turned out to be neglected, one cannot do without laboratory seeding of fistulous secretions in order to determine sensitivity to different groups of antibiotics. The result of planting will help identify the causative agent of infection.

When it comes to sluggish course of the disease, it is more effective to start the course with anti-inflammatory therapy. It includes antibacterial pharmacological agents, selected according to the results of a clinical study of seeding. Local treatment aimed at washing the problem area with special antiseptic solutions will not interfere.

Approximately three days before the appointed date, a diet is prescribed, which excludes foods with fiber and causing increased gas formation. These include:

  • vegetables and fruits in their raw form;
  • black bread;
  • legumes;
  • sweets;
  • pure milk;
  • carbonated drinks.

The night before is to clean the intestines with an enema or taking pharmaceutical means. The list of the latter should be clarified in advance with the attending physician. It is also necessary to remove the hair from the crotch area.

Before sending a radiowave excision ward or other type of procedure to the ward, a specialist will definitely check for possible contraindications for his wards. Medical prohibitions include:

  • general serious condition;
  • infectious lesions in the peak period;
  • decompensation of chronic illness;
  • problems with blood clotting;
  • renal failure;
  • liver failure.

Doctors agree that during a persistent quenching of the inflammatory process, when no elements stand out from the fistula, it is not necessary to perform the procedure. This is explained by the fact that the hole could itself temporarily be drawn into granulation tissue. Finding it, especially with a small diameter, will be a challenging task.

Operational classification

Regardless of whether the technique is implemented with a ligature, or a simpler technique, the patient is shown general or epidural anesthesia. The reason for this - the need to make the muscles completely relax. For the convenience of the victim, he is offered to sit in a special proctological chair, which resembles an ordinary gynecological chair.

Based on the type of hole and other features of the pathology, the doctor will choose one of several types of excision methods:

  • dissection;
  • an incision along the entire length, followed by closure or lowering of this stage;
  • ligature;
  • removal with plastic;
  • laser cautery;
  • filling with biological materials.

At the same time, the intra sphincter and transsphincter versions are necessarily neutralized towards the rectal cavity in the form of a wedge. Even skin sites and the accompanying cellulose are leveled. If necessary, allows for suturing of the sphincter muscles, which is characteristic of the defeat of the deeper layers.

If there was a place of purulent accumulation, then it is first opened, cleaned, and then drained. The open wound surface is covered with an ointment swab.

To simplify the implementation of household actions, the victim is installed a vapor pipe.

It is much more difficult for those who have become victims of extrasphincter fistulas. Due to the fact that they are much deeper, it increases their length.

Often they affect two deep zones:

  • pelvic-rectal;
  • sciatic rectus.

The presence of several branches of purulent cavities complicates the work of the surgeon, who will have to eliminate all of the above, and at the same time arrest the connection with the rectum. Additionally, you will have to take care of minimal intervention on the sphincter to prevent its lack of functionality in the future.

To increase the chances of a successful outcome, physicians actively attract a ligature. After the dangerous hole is cut, a silk thread is introduced into its inner part along the formation, leading it out. It is necessary to lay the thread so that it is closer to the midline of the anus. Sometimes there can not do without threading the cut, but such a sacrifice is justified. Next, the ligature is tied to the state of complete girth of the muscular layer of the anus.

During each ligation, the ligature is gradually tightened up to the final eruption of the musculature. Thanks to such a careful approach, it turns out to cut the sphincter gradually so as not to trigger the mechanism of its failure.

Another option for the development of events is the removal of the hole with the subsequent closure of the inside of the rag from the rectal mucosa.

Quick Recovery Guide

For rehabilitation to be completed as soon as possible, you will need to adhere to bed rest for the first few days. A little more than a week will have to be spent on following the rules of individual antibacterial therapy.

After successful neutralization of the lesion will have to work hard to delay the chair for about five days. It will help in this special diet food, aimed at the absence of slag formation. If there is enhanced peristalsis, the doctor will prescribe the appropriate medication to relieve symptoms.

The first dressing occurs on the third day. Here it is worth preparing for the fact that the process itself is rather unpleasant, therefore, physicians in the first times prefer to carry out the relief of pain by anesthetic drugs.

Tampons previously placed on the wound surface are first impregnated with hydrogen peroxide and then removed. The wound itself is also treated with hydrogen peroxide along with antiseptics, and then loosely filled with fresh tampons with ointment. To accelerate healing, a strip with ointment is inserted into the rectum itself.

And already after the four-day quarantine, the use of specialized candles is allowed. If the next day after this to defecate fails, then you need to use a cleansing enema.

The list of approved products for the first time of the postoperative period includes:

  • semolina boiled in water;
  • broths;
  • Steamed patties;
  • boiled fish;
  • omelette.

But there is no particular limitation in drinking. But all meals served to the table should not be salty, do not include seasonings.A few days later, while maintaining positive dynamics, it is allowed to add some more products to the main menu:

  • mashed boiled potatoes and beets;
  • fermented milk products;
  • fruit puree and baked apples.

Still, soda, raw vegetables with fruits, legumes, alcoholic beverages are still prohibited.

After each trip to the toilet to facilitate the state and additional disinfection will have to do sedentary baths. The proctologist selects the solution for them individually. He will say exactly when you can remove the seams, but the average period is often about a week. A few more weeks will be needed before the final healing.

Partial incontinence of feces and gas in the next couple of months is a standard reaction of the body, so this is not a reason to sound the alarm. To improve the clinical picture, it is necessary to train the sphincter muscles, using a special set of exercises for this.

Risks of complications

Even if the procedure is performed by an experienced surgeon with the help of qualified medical personnel, there is still a small percentage of the likelihood of complications. If the intervention was performed in a hospital, then 90% of patients are recovering according to a standard plan.

But some due to the nature of the organism, or medical errors, have to put up with a number of side effects. Among them, the most common bleeding occurs not only during the procedure, but also after its completion.

Even less often in medical practice, damage to the urethra is recorded. But the postoperative wound suppuration usually always lies on the shoulders of the victim, who has not carefully executed the precepts of the personal hygiene regulations.

Relapse occurs only in 15% of cases, which provokes a chronic form of the course. But even with it you can fight.

In some victims after surgery, the viability of the anal sphincter has not even partially recovered. This guarantees incontinence of feces and gas, which greatly complicates social life. To avoid this, experts advise to seek qualified help at an early stage of fistula formation.

Watch the video: IBD Surgery: Perianal abscess and fistula (November 2019).