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HOW I DO IT / HOW I DID IT SURGICAL PROCEDURES |
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FISTULA-IN-ANO
OPERATIVE TECHNIQUE § Patient lying supine in lithotomy position § Asepsis, antisepsis § Sterile drapes placed § External opening noted § Fistulous tract and internal opening identified by inserting a probe through the external opening and simultaneously palpating the anal canal § Cannulate internal opening from the outside § Intersphincteric Fistula -- Simple Low Fistula § Place a rectal speculum and insert anal circumference § Divide internal sphincter and overlying anoderm up to the internal orifice of the fistula approximately at the dentate line
Transsphincteric Fistula -- Uncomplicated § Insert a probe through fistulous opening in the skin and along the track until it enters rectum at internal opening of fistula § Divide all the overlying tissue § Occasionally one of these fistulas crosses the external sphincter closer to the puborectalis muscle. In this case, if there is doubt that entire puborectalis can be left intact, external sphincter may be divided in two stages. Divide distal half in first stage § Insert a seton through remaining fistula, around remaining muscle bundle, and leave it intact for 2 months before dividing remainder of sphincter |