Treatment of Complex Perianal Fistula - Case Presentation

Milev, Ilija and Mitevski, Aleksandar and Lazovski, Nikola and Georgiev, Alen and Velkov, Gjorgi (2010) Treatment of Complex Perianal Fistula - Case Presentation. In: 7th Biannual International Symposium of Coloproctology, 07-09 Oct 2010, Belgrade, Serbia.

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A perianal fistula is a pathological canal outlined with granulation tissue and lined with epitilium from anal glands that connects internal opening in the anal canal with external opening or openings at the perianal skin. We are presenting a 51 years old patient with 15 years old history of perianal fistula. On preoperative evaluation by passing a probe trough the fistulous canal and entering the internal opening at the posterior midline it was concluded that the patient has a high posterior transsphincteric fistula with high blind tract. Additionally on DRE excellent resting and squeeze anal pressure were concluded. The operation was done with spinal anesthesia in a lithotomy position. Initially fistulectomy around the probe till the external sphincter was done. Then proceeded fistulotomy of the whole tissue above the probe by cutting through the whole external sphincter after it was concluded that the pressure at the anorectal ring is sufficient. The granulation tissue around the internal opening was thoroughly excised and the additional incision was made toward the coccyx for wide opening of the deep postanal space. Endotracheal tube was put in the rectum and the wound was pack eith petroleum gaze. On the 1th postoperative day the patient was aloud to eat and the tube was removed the second day when 3-4 sitz baths per day were started. On the 5th postoperative day the patient was discharged with advice for weekly visits. Approximately 5 months after the operation the wound is completely sealed and the patient has no trouble with continence for gas, liquid or solid stool. In conclusion if the pressure in the anal canal on the preoperative evaluation is sufficient it is safe to cut through the whole external sphincter posteriorly in order to make a radical operation for complex posterior perianal fistula as long as m. puborectalis is intact.

Item Type: Conference or Workshop Item (Poster)
Subjects: Medical and Health Sciences > Clinical medicine
Divisions: Faculty of Medical Science
Depositing User: Ilija Milev
Date Deposited: 11 Sep 2019 09:13
Last Modified: 11 Sep 2019 09:13

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