home Calculators Causes of non-healing wounds after excision of the fistula. Open wound after excision of the fistula of the rectum. Fistula of the anus - treatment at home

Causes of non-healing wounds after excision of the fistula. Open wound after excision of the fistula of the rectum. Fistula of the anus - treatment at home

The appearance of a fistula on the body of a person who has recently undergone surgery is a kind of complication in the process of restoring damaged epithelial tissues, when the regeneration of their cells does not occur or is carried out at a slow pace. Many factors affect such a pathological condition of the operated area of the body, but in most cases it is the ingress of infectious microorganisms into the wound, provoking a purulent-inflammatory process, as well as a severely weakened patient's immune system.

A postoperative fistula is a through canal that is hollow inside and connects the organs located in the peritoneum with the environment. According to its etiology and symptoms, the pathology is considered extremely dangerous, as it prevents stable wound healing. This increases the likelihood that microbes, viruses and fungal infections will enter the internal organs, which can cause many secondary diseases of varying severity. After the operation, its formation is associated with the lack of normal dynamics of the band suture healing.

The very nature of fistula formation is such that it is formed during the acute phase of inflammation, when purulent masses accumulated in the subcutaneous layer break through the epithelium, drain naturally and go outside, creating a hole in the abdominal cavity or on any other part of the body. The most common in medical practice are fistulous lesions of the abdominal cavity and lower extremities. This is due to the physiological and anatomical structure of the human body.

Reasons for education

In modern surgery, it is generally accepted that prolonged non-healing of the wound surface formed after surgery is a complication that requires medical, and sometimes even surgical treatment. For it to be effective, it is extremely important to establish a factor contributing to the development of the pathological condition of the suture. The following causes of postoperative fistulas of various localization and severity are distinguished:

improper wound care, lack of antiseptic treatment with specially designed solutions (Chlorhexidine, Miramistin, Hydrogen Peroxide, Iodocerin), rare replacement of the dressing material;
the entry of pathogenic microflora directly at the time of the operation, if surgical instruments and threads that have undergone insufficient sterilization are used, or infection occurs during the rehabilitation process;
low-quality suture threads were used, which led to a negative reaction of the body and their rejection began with extensive inflammation and the formation of purulent masses;
reduced immune status of the patient, when the cells responsible for suppressing the activity of pathogenic microflora are not able to cope with the functional duty assigned to them and the entry of even non-dangerous strains of microorganisms into the wound leads to a purulent lesion of the epithelium with the formation of a hollow drainage channel (fistula);
excess body weight, when a thick layer of adipose tissue excludes the normal regeneration of epithelial cells (the cut part of the body simply cannot physically grow together, since fat exerts constant static pressure on the wound);
the senile age of the patient (patients who are already 80 years old and older, very poorly tolerate not only the surgical intervention itself, but also the recovery period of the body, because the cells responsible for the formation of fibrous tissue, from which the suture scar is formed, divide at a too slow pace) ;
medical negligence and leaving surgical instruments in the abdominal cavity (such cases occur periodically in various countries of the world, and their occurrence is associated with insufficient care of medical personnel immediately at the time of the operation).

Timely elimination of these causative factors can ensure a stable recovery of the human body in the postoperative period, as well as avoid the development of inflammatory processes.

How to treat a fistula after surgery?

The appearance of a postoperative channel through which purulent contents flow out is not a death sentence for the patient. The main thing is to start pathology therapy in a timely manner so that the fistula does not cause the occurrence of concomitant diseases of an infectious nature of origin. To do this, the patient is prescribed the passage of the following therapeutic measures.

Antibiotics

Flushing the seam

Completely the entire band wound and the resulting fistula are subjected to daily cleansing with antiseptic solutions. Hydrogen peroxide with a concentration of 3%, Chlorhexidine, Miramistin, Iodocerin, manganese water are most often attributed. The procedure is performed 2-3 times a day to cleanse the tissues of purulent secretions and microbes.

Surgical debridement

Quite often, the fistula forms a scar, consisting of fibrous tissue that is not able to grow together. As a result, a hole appears, which by itself is no longer capable of healing. To eliminate this pathology, the surgeon cuts off the edges of the fistula in order to start a new process of regeneration of open tissues.

Before surgery with the help of antibiotics, the complete elimination of infectious inflammation is ensured. Otherwise, the operation will only lead to the expansion of the diameter of the fistula. The described complex treatment of a non-healing wound provides a gradual overgrowth of the inflamed wound with the relief of the drainage channel.

Some diseases in terms of proctology require the use of surgical intervention. This radical method also eliminates the fistula of the rectum, the so-called hole in the subcutaneous fat layer, which is usually located next to the anus.

Feces constantly get into the fistulous passage, which causes a strong inflammatory process, pus is released. Such an ailment creates discomfort and danger to the life of the patient.

Causes of the problem and symptoms

In most patients, such a deviation is associated with the manifestation of paraproctitis in an acute form. This is because some people turn to a specialist for help too late and the internal abscess spontaneously comes out.

After the pus flows out, the patient will feel relief. However, the inflammatory process will continue further, thereby new tissues are affected, which melt gradually, forming a fistula.

Holes form again until the inflammatory process is completely eliminated.

Sometimes this problem occurs due to errors during surgery:

If the abscess is opened and the drainage is removed, and the subsequent operation is not carried out.
When, during the elimination of hemorrhoids, the mucosa is sutured and the fibers of the muscle tissue are captured, after which an inflammatory process is formed.

A fistula may also appear during the rehabilitation period after surgery for complicated hemorrhoids. And also the cause of the disease is traumatic injuries during natural childbirth and gynecological disorders.

Sometimes the problem occurs under the influence of the following factors:

oncological tumors in the rectal cavity;
sexually transmitted diseases in the advanced stage;
tuberculosis disease of the intestine;
amputation of any organ of the urinary or reproductive system;
infectious diseases;
permanent disturbance of the stool.

Usually, the symptoms of such a deviation are manifested by severe pain in the anus. In addition, puffiness is formed, there are difficulties with emptying. The patient's body temperature may rise sharply, general weakness is observed.

Sometimes the following symptoms appear:

bloody and mucous discharge from the rectum;
sensation of a foreign object in the anus.

This condition can be observed for 7-14 days. After that, the pus flows out, an unpleasant odor appears, irritation occurs on the skin, which provokes discomfort.

Methods of operations on the fistula of the rectum

The fistula of the rectum is removed by surgery under general anesthesia. The patient needs to lie on his back, bend his knees, so the surgeon will have full access to the anus.

The method of surgical intervention is determined only by a specialist, it will depend on the stage of the inflammatory process.

The following types of operations are carried out:

opening of a purulent lesion;
complete removal of the fistula followed by tissue closure;
excision of the fistula into the lumen of the anus;
the use of a laser for burning;
filling the hole with special biomaterials.

The most common operation is the excision of the fistula to the anus. However, this method has many disadvantages. Because often there are subsequent relapses. And also such an operation violates the external structure of the sphincter.

The elimination of the fistula along the entire cavity is carried out together with parts of the dermis. If the inflammatory process has affected the deeper subcutaneous layers, then it becomes necessary to suture parts of the sphincter. If there are purulent bags, they should be thoroughly cleaned, and swabs with an antiseptic should be placed in the anus.

With the help of a laser, only small fistulas are eliminated, without numerous purulent lesions. Laser burning is the most painless method of intervention that does not require general anesthesia and extensive incisions.

Before the operation, the following preparation is necessary:

stool analysis;
examination of the condition of the skin;
diagnostics by specialized specialists.

If there is a release of pus, then it is also sent for research. Immediately before the operation, the patient needs to clean the intestines.

Rehabilitation after laser removal of the fistula of the rectum is much faster than with radical surgery. And also the implantation of the hole with the help of biological material, which promotes healing, has gained popularity. This method began to be used in medicine quite recently, so it is still little studied.

Surgical intervention for excision of the fistula is carried out strictly according to plan. However, with an exacerbation of paraproctitis, the operation is performed urgently, and only after some time, the abscess is opened.

Recovery after surgery

After surgery, the patient is required to stay in bed for a week and treat the damaged area with antiseptics. For this period, a strict diet is prescribed, as well as antibiotic therapy, if necessary.

On the 3rd day after the operation, the first dressing should be performed, usually this process is very painful, so the patient is given an anesthetic. Already on the 4th day, rectal suppositories can be inserted into the anus.

Immediately after surgery, it is allowed to use the following products:

porridge on the water;
steam cutlets;
milk omelets.

After a few days, it is allowed to eat boiled vegetables, as well as mashed potatoes. It is strictly forbidden to take alcoholic beverages and introduce raw fruits and vegetables into the diet during the entire rehabilitation.

It is necessary to carefully monitor changes in the patient's condition, especially if the following signs occur:

bleeding from a wound;
pathology of the urethra;
excessive secretion of pus.

Approximately 1 week later, the external sutures are removed, subject to healing. The patient is advised to perform special exercises to train the sphincter.

Fistula of the rectum ( chronic) - an inflammatory process in the anal canal with the formation of a pathological passage between the skin or subcutaneous tissue and the cavity of the organ.

Represents pathological formation that connects the intestine to the external environment. With paraproctitis, the following types are distinguished:

Full stroke, having an external opening on the skin and an internal opening in the intestinal lumen.
Incomplete fistulas, characterized by the presence of only an internal opening. In most cases, they are transformed into a full form after the melting of external tissues.
If both holes are within the intestine, then the formation is called an internal fistula.
If the course has branches or several holes, it is called complex. Rehabilitation after the operation of the fistula of the rectum in such cases is delayed.

In relation to the location of the anus allocate extra-, intra- and transsphincteric fistulous passages. The former do not come into direct contact with the sphincter, the latter have an external opening near it. The crossphincter always passes through the external sphincter of the rectum.

Symptoms

Through the fistulous opening into the environment occurs discharge of purulent or bloody contents which may cause skin irritation. Also, patients may complain of itching in the perianal area.

Pathological secretions cause psychological discomfort, there is constant contamination of linen and clothing.

The sick are worried pain syndrome varying degrees of expression. Its intensity directly depends on the completeness of the drainage of the fistula. If the exudate is evacuated in full, the pain is weak.

In the event of a delay in the anal zone secreted in the tissues, the patient will be disturbed by severe discomfort. Also, the intensity increases with sudden movements, walking, sitting for a long time, during the implementation of the act of defecation.

A feature of the course of chronic paraproctitis is alternating periods of remissions and exacerbations. A complication may be the formation of abscesses, which can open on their own. Fistulas of the rectum sometimes contribute to the replacement of normal scar tissue, which leads to deformation of the rectum and the adjacent area.

Patients experience insufficient functionality of the sphincter as a result of its narrowing. The danger of a long-term presence of a fistula lies in the possibility of the affected tissue becoming malignant.

The protracted course of the disease negatively affects the general condition of the patient. Gradually, patients become emotionally labile, irritable. There may be problems with sleep, memory and concentration deteriorate, which negatively affects the implementation of labor activity.

When to have surgery

The protracted course of the pathology is an undoubted indication for surgical intervention.

Usually this duration lasts for years, the periods of remission gradually become shorter, the general condition of the patient worsens.

The presence of the latter can significantly complicate the work of proctologists. Reviews of the treatment of rectal fistula without surgery are not encouraging, basically all patients come to the conclusion that intervention is necessary.

Read about treating rectal fistula without surgery.

The course of surgical interventions

There are several types of operations in the treatment of rectal fistula.

Dissection of a pathological formation can be carried out by two methods - ligature and one-stage incision.

At the first fistula and surrounding tissues are tied with threads. The resulting ligature is untied and re-tied every 5 days, gradually cutting off pathological tissues from healthy ones. The entire course of the operation is usually carried out in a month. A significant drawback of the method is long healing and prolonged pain after, and the functionality of the anal sphincter may also decrease in the future.

The method of one-stage excision is simpler and more affordable. A surgical probe is passed through the external opening into the fistulous canal, the end of which must be brought out of the anus. After the probe is dissected pathological tissues. A lotion with a healing ointment is applied to the resulting wound surface. The area of surgical intervention gradually heals and epithelializes.

One-stage dissection has disadvantages - long wound healing, the risk of recurrence, the ability to touch the anal sphincter during surgery.

The next variety means simultaneous excision with suturing of the resulting wound surface. Differences are in the methods of suturing.

The first way is to sew the wound tightly. After dissection and removal of pathological formations, streptomycin is poured inside. Then the wound is sutured in several layers with silk threads.

The sutures are removed approximately 2 weeks after the operation. They are strong enough, the risk of discrepancy is minimal.

The second method implies a fringing incision around the fistula. The latter is completely removed to the mucous membrane, after which the surface is covered with antibacterial powder, the wound is sutured tightly. Suturing can be carried out both from the outside and from the side of the intestinal lumen.

Some surgeons prefer not to suture the wound tightly, only its openings. Swabs with ointments are applied to the lumen to promote healing. This technique is rarely practiced, since the risk of discrepancy is quite high.

Another method is that after complete excision of the fistula, skin flaps are sutured to the surface of the wound, which contributes to its faster healing. The method is quite effective, since relapses are rare.
Sometimes when removing a fistula, the intestinal mucosa can be brought down, which means its hemming to the skin. The peculiarity of this surgical intervention is that the fistula is not removed, but is covered on top of the mucosa. Thus, the pathological canal gradually heals on its own, since it does not become infected with intestinal contents.
The most modern methods are laser cauterization of the fistula or its sealing with special obturator materials. The techniques are very convenient, minimally invasive, but applicable only to simple formations that do not have complications. Photos of the fistula of the rectum after surgery with a laser or filling indicate that this technique is the most cosmetic, helps to avoid cicatricial changes.

Photo of a fistula of the rectum

Important It should be noted that the main goal of any type of intervention is to preserve the functioning of the sphincter in full.

Postoperative period

Postoperative period of excision of the fistula of the rectum the first couple of days requires bed rest. An important condition for successful rehabilitation is compliance with diets. The first 5 days you can eat cereals on the water, steamed cutlets, low-fat broths, boiled fish.

The diet after the operation of the fistula of the rectum after this time period is expanded, boiled vegetables, fruit purees, yogurts can be added to the menu. Prohibited alcoholic and carbonated drinks, raw fruits and vegetables, peas, beans.

During the week is antibiotic therapy broad-spectrum drugs.

The patient should have a stool 5 days after the operation, if this does not happen, an enema is indicated.

Patients undergo dressings with anti-inflammatory and analgesic drugs. It is acceptable to use rectal suppositories to reduce pain.

It is important after the act of defecation to toilet the wound with antiseptic solutions.

Stitches are removed after 7 days, full recovery after fistula surgery occurs 3 weeks after the intervention.

How to avoid relapse

Despite all the measures taken, in 10-15% of cases, a recurrence of the disease may occur. This usually occurs with complex moves, incomplete implementation of the volume of intervention, rapid fusion of the edges of the wound while the channel itself has not yet healed. Symptoms of recurrent fistula of the rectum after surgery are the same as before.

If after a while they begin to disturb the patient, this indicates the need to consult a doctor again.

To avoid this it is necessary to constantly carry out hygiene procedures, it is better after each act of defecation (normally it occurs 1 time per day), treat anal fissures and hemorrhoids in time, sanitize sources of chronic inflammation in the body.

Also important to avoid constipation. For this purpose, you need to drink a sufficient amount of liquid, do not eat gas-producing foods. The patient should avoid obesity and try to maintain the glucose level within the normal range.

Taking into account the type of paraproctitis, surgical treatment is also carried out, which can be emergency or planned. Regardless of the type of surgical intervention, the main direction of treatment is the opening of the abscess with the removal of the inflamed anal crypt and the anal glands involved in the process, as well as the evacuation of pus.

But here the second, postoperative part of the treatment is also obligatory.

Postoperative treatment of paraproctitis

After the operation, the patient must comply with all the instructions of medical workers without fail. Shortly after waking up, the effect of anesthesia ends, and discomfort and pain are felt at the site of the postoperative wound, while painkillers are often prescribed.

The use of sparing and light food and drink is allowed a few hours after the operation. Excessively sweet or salty, fried, spicy, and gas-producing foods are contraindicated.

The postoperative bandage on the wound is removed the next day. This procedure may cause discomfort.

Although the recovery of the chair after the operation occurs in two or three days, in some cases it is necessary to prescribe a cleansing enema. The patient can stay in the hospital after the operation from several days to a week and a half, this is determined by the condition and well-being of the patient, as well as the complexity of the operation performed.

In acute paraproctitis, treatment after surgery consists in daily dressing of the wound using antiseptics.

Every day, the wound is bandaged using antiseptics (chlorhexidine, betadine, dioxidine, iodopyrone, and others) and antibacterial ointments such as Fusimet and Levomekol, in addition, to accelerate tissue regeneration. Each dressing should be accompanied by a medical check of the correctness of healing, while the wound, as it were, “opens up” so that regeneration occurs from the bottom. This event is characterized by discomfort, so painkillers are often prescribed in parallel.

Physiotherapeutic procedures such as ultra-high frequencies of 40-70 W, ultraviolet irradiation and microwaves of 20-60 W are also performed.

The most suitable procedure for the patient is carried out, daily for ten minutes, the duration is from five days to two weeks, and in some cases more.

In the postoperative period, complications are less common and patients feel better. Postoperative treatment is similar to the measures taken for acute paraproctitis. These are, in particular, daily dressings with local antibacterial agents and antiseptics, while the use of systemic antibiotics is carried out according to indications after plastic surgery for rectal fistula, such as severe postoperative inflammation in the wound.

Also, according to indications, laxatives and a diet according to indications after plastic surgery are prescribed. The meaning of the diet is to soften the stool, for this it includes dried fruits, lactic acid products, and the consumption of raw vegetables and fruits is limited.

Bloody discharge from the rectum or wound after surgery for paraproctitis is normal, but requires a mandatory visit to the doctor.

It should be firmly remembered that the postoperative period with paraproctitis lasts at least twenty days, but often more. Dressings are carried out for three to four weeks. Even with home dressings, it is necessary periodically.

In particular, your attending physician must be aware that after the operation, the wound does not heal for a long time. Perhaps paraproctitis, especially chronic, cannot be cured in the presence of a fistula, and in this case, palpation will show an overgrown fistula. Here, a second operation is already needed, but it can be carried out no earlier than in a year. It is possible that a non-healing wound is associated with bacterial complications, which requires the appointment of antibiotics in tablets or injections locally and systemically.

Excision of the fistula of the rectum is the only effective format for helping victims with such a serious illness. No alternative treatment option can provide such a high guarantee of the effectiveness of a positive result. This is confirmed by the reviews of patients who pulled to the last, trying to help themselves on their own, attracting folk remedies. Doctors insist that with a confirmed diagnosis, it is impossible to delay the neutralization of the fistula for a long time, since it quickly increases in size. The larger the diameter, the more difficult the operation will be. You will also have to come to terms with the fact that the recovery will stretch for a rather long period.

A fistula with localization in the rectum is an opening in the wall of the intestine. It continues with a course in soft tissues, ending with an exit to the outside. Often the exit hole is located in the skin of the perineum, which adds to the inconvenience to the victim.

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

Fistula classification

Before sending the ward to do an excision, the doctor must definitely figure out what kind of fistula format is the place to be in each case. This will allow you to choose the best type of assistance, 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 is a logical consequence of the course 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 on its own without surgical intervention, damaging the integrity of the perirectal tissue. But just in this situation, a person will become a victim of an external fistula or its other variety.

Sometimes patients ask to do without a radical technique, preferring an alternative intervention. It provides only for the opening of the abscess itself in order to release the accumulated dangerous contents of the "purulent sac". But such an approach does not provide for the neutralization of the purulent course itself, which is why the risk of recurrence rises to 50%. This means that the wound after the first opening will be a good environment for the re-accumulation of contents that threaten healthy tissues.

Even a full laser excision does not always give a 100% guarantee of a successful outcome. So, about 10% of all clinical cases of successful disposal of the primary fistula threaten to transform into a chronic form of the course of the disease. In order to reduce the percentage likelihood of such a serious complication, doctors recommend immediately, upon detecting profile symptoms, sign up for a consultation with.

A little less often, the following pathologies become provocateurs for the growth of the hole:

ulcerative colitis of chronic type;
rectal cancer;
Crohn's disease.

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

It relies on the following types of specified anomalies:

Full. Includes two holes that are localized in the intestinal wall and on the skin.
Incomplete. It has only one outlet: internal or external.
Simple. Provides only one move.
Complex. It is based on several moves, which include many branches.

The price of treatment just depends on which version of the diagnosis was found in the victim. Also, the pricing policy can be influenced by the format of the hole, which relies on the location in relation to the sphincter.

There are three categories in total:

intrasphincteric, which crosses only part of the fibers of the outer part of the organ;
transsfikternaya, which crosses the entire sphincter;
extrasphincrete, which passes outside the sphincter.

The latter class is usually based so highly that it provokes the formation of complex multi-way fistulas. They are the hardest to fight against.

Tactical decision

Almost 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 the final diagnosis is made, you continue to try to help yourself on your own, then this will only aggravate the clinical picture, worsening your general state of health. Since stool enters the lumen on a regular basis, it constantly infects the surrounding unprotected soft tissues. Because of this, the inflammatory process enters the chronic phase.

In addition to feces, mucus, pus, and ichor are released through the hole. Together, this causes great inconvenience to the patient, forcing him to use sanitary napkins. An additional complication is the unpleasant smell, which confuses the victim, forcing him to limit his social life.

After a while, when ignoring the alarming symptoms, a person will definitely encounter a weakened immune system, which will become a green light for the penetration of other infections.

So one fistula becomes the cause:

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

Prolonged failure to provide assistance acts as a guarantor of the formation of scar tissue instead of normal sphincter fibers. Not only does such a scar hurt, it also leads to the failure of the anal press. This becomes a “habit” for the sphincter, and the person ceases to control not only the release of gases, but also feces.

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

The disregard for one's own health ends with the fact that the disease smoothly flows into an oncological neoplasm of a malignant nature with rapidly spreading metastases.

Here you can not 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, it is necessary to remove the problem layer to healthy tissue. Only laser excision or a similar version of the cut of the lesion can help with this.

Preparatory stage

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

Usually, with extensive lesions, the proctologist insists on immediately opening the abscess by cleaning out the purulent cavity. Only after success at the first stage is it allowed to proceed with the neutralization of the passage itself. Usually between stages takes about a week and a half. The exact period will be announced, based on the individual dynamics of the recovery of the ward.

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

sigmoidoscopy, which helps to assess the internal state of tissues;
fistulography, which covers radiopaque examination;
ultrasonography;
computed tomography of the pelvic organs to assess the condition of neighboring internal organs.

It does not do without a standard package of tests, which includes a study of blood, urine, biochemistry, an electrocardiogram, fluorography, a conclusion,. Separately, a preliminary allergic test is carried out, which allows blocking the risks of developing anaphylactic shock due to intolerance to the components of anesthesia.

Patients who have a number of chronic ailments deserve special attention. They will have to first consult with specialized doctors, who should review the current approved treatment program to ensure there is no drug conflict.

But it is strictly forbidden to independently change, or even interrupt the prescribed drug therapy regimen. It is likely that the attending physician will recommend waiting a few weeks to complete the course, and then proceed with the surgical intervention. The rule applies to those who suffer:

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

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

When it comes to the sluggish course of the disease, it is more effective to start a course with anti-inflammatory therapy. It includes antibacterial pharmacological agents selected according to the results of a clinical study of culture. 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 that excludes foods with and causing increased gas formation. These include:

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

Before sending a ward a radio wave excision or another type of procedure, the specialist will definitely check for possible contraindications in his wards. Medical restrictions include:

Doctors agree that during a persistent extinguishing of the inflammatory process, when no elements are released from the fistula, it is not worth performing the procedure. This is explained by the fact that the hole could independently temporarily tighten with granulation tissue. Finding it, especially with a small diameter, will be a problematic 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 is the need to force the muscles to completely relax. For the convenience of the victim, he is offered to sit in a special proctological chair, which resembles a conventional 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;
incision along the entire length, followed by suturing or lowering this stage;
ligature;
removal with plastic;
laser cauterization;
filling with biological materials.

In this case, intrasphincteric and transsphincteric versions are necessarily neutralized in the direction of the rectal cavity in the form of a wedge. Even skin areas and associated fiber are leveled. If necessary, it allows suturing of the sphincter muscles, which is typical for damage to the deep layers.

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

To simplify the performance of household activities, a gas outlet tube is installed for the victim.

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

Often they affect two deep zones:

pelvic-rectal;
sciatic-rectal.

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 stop the connection with the rectum. Additionally, you will have to take care of minimal intervention on the sphincter in order to prevent its insufficient functionality in the future.

To increase the chances of a successful outcome, doctors are actively attracting a ligature. After the dangerous hole is excised, a silk thread is inserted into its inner part along the course of formation, leading out. It is necessary to lay the thread so that it is closer to the midline of the anus. Sometimes you can not do without threading the incision, but such a sacrifice is justified. Next, the ligature is tied up to the state of full girth of the muscle layer of the anus.

During each dressing, the ligature is gradually tightened until the final eruption of the muscles. Thanks to such a careful approach, it turns out to cut the sphincter gradually so as not to trigger the mechanism of its insufficiency.

Another option for the development of events is the removal of the hole, followed by closing the inside with a flap from the rectal mucosa.

Focus on a quick recovery

In order 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 following the rules of individual antibacterial therapy.

After successful neutralization of the lesion, work will have to be done to delay the stool for about five days. A special dietary food, aimed at the absence of the formation of toxins, will help in this. If there is increased peristalsis, the doctor will prescribe appropriate medications to relieve symptoms.

The first dressing occurs on the third day. Here it is worth preparing for the fact that the process itself is quite unpleasant, therefore, for the first time, doctors prefer to relieve pain with painkillers.

Swabs 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 swabs with ointment. To speed up healing, a strip of ointment is injected into the rectum itself.

And after a four-day quarantine, the use of specialized candles is allowed. If the next day after this, it is not possible to defecate, then you need to use a cleansing enema.

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

semolina porridge, cooked on;
broths;
steamed cutlets;
boiled fish;
omelette.

But there are no special restrictions on drinking. But all dishes served to the table should not be salty, do not include seasonings. After a few days, while maintaining positive dynamics, it is allowed to include some more products in the main menu:

mashed boiled and;
dairy products;
fruit puree and baked .

All the same, soda, raw vegetables with fruits, legumes, and alcoholic beverages are still prohibited.

After each trip to the toilet, to alleviate the condition and additional disinfection, you will have to do sitz baths. The solution for them is selected by the proctologist individually. It is he who will tell exactly when the stitches can be removed, but the average period is often about a week. It will take a few more weeks before the final healing.

Partial incontinence of feces and gases 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 required 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 carried out in a hospital setting, then 90% of patients recover according to the standard plan.

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

Even less often in medical practice, damage to the urethra is recorded. But the suppuration of a postoperative wound usually always lies on the shoulders of the victim, who did not follow the precepts of the personal hygiene charter accurately enough.

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

In some patients, after the operation, the consistency of the anal sphincter is not restored even partially. This guarantees incontinence of feces and gases, which greatly complicates social life. To avoid this, experts advise seeking qualified help at an early stage of fistula formation.