Anal fistula treatment
The anal dents make communicate the interior of the anus with the skin périanale. The results of the surgery are very satisfactory: rate repeats from 1 to 2%.
At the stage of the abscess, most important is to relieve the pain by evacuating the pus by an incision. But remains to treat the dent.
The treatment of the anal dent is currently surgical and obeys two requirements: to cure the dent and to preserve the anal continence since the muscles which ensure this continence are crossed by the dent.
This is why, in certain forms, one will be obliged to proceed in several operational times.
1°) low dents
It do not require qu ` only one operation.
One locates the way and the primary education opening by a dye injected by the opening interns and one removes it to the muscle which is simply divided.
The post-operative care is simple, there is not or little pain.
This intervention can be done either with 48 hours a short hospitalization, or into ambulatory.
The cicatrization can take eight weeks.
The complications are very rare (hypocontinence with gases in approximately 1% of the cases).
The repetition in the centers accustomed to this kind of surgery is approximately 1%.
2°) higher dents
It are rarer and must be operated twice after a free interval of approximately 2 months.
In the first operation, one withdraws the way to the muscle on which one places a wire without traction (the seton).
The post-operative care is twice-daily with cleaning of the wound and the average duration of hospitalization is from 2 to 3 days.
There still, one follows the patient until cicatrization supplements .et at this time there, one will be able to practise the second intervention.
It consists is in a progressive section of the muscle by the wire which is tight the every 8-10 days, that is to say by a direct section.
The complications are not very frequent: seepages in 2% of the cases, hypocontinence to gases and urgency to go to the saddle when they are liquid in 11%. These problems regress with time.
The repetition is approximately 2% in the dedicated services or having the habit of this kind of surgery.
3°) typical cases
The horseshoe dent requires sometimes three operations, the intra-mural dent is open towards the interior of the rectum.
Lastly, certain particularly complex or polyopérées dents do not have systématisable treatment.
Techniques of safeguarding sphinctérienne
It is always shocking to cut a muscle which has an important function.
This is why, of research are directed towards the conservation of the muscle in the treatment of the anal dents.
the scrap of advance (flap):
The way is removed to the muscle and to the level of the rectum, one lowers a muco-muscular scrap to cover the primary education opening. The currently available results are unmatched and this technique still requires other studies.
One injects a “adhesive” in the sinus way for the butcher.
The results are still preliminary, promising in the simple dents.