Fistulotomy is a surgical procedure used for the treatment of fistula / A>, which occurs when two organs or treaties form an abnormal connection.The phystulotomy is used more frequently to treat the fistula Periana without complications (those that occur in and around the anus).
They usually occur when the abscess develops in perianal tissues and breaks through the walls of neighboring structures, as it grows.Fistulotomy can help open and combine your pocket so that fabrics can cure and close abnormal passage.
What are the firitles?
Fistulas can be developed in different parts of the body as a result of an infection, injuries, surgery or severe inflammation .Fistulotomy is one of several methods that can be used for treatment, but generally reserved for cases associated with anus or rectum.
More specifically, fistulotomy is mainly used to treat simple Fijstulastasthat, those that are low (next to anal sphincters), which have a hole between adjacent structures. .Large fistulas may be needed to be treated in an operational hospital within the framework of general anesthesia .
This operation should not be confused with a phystultectomy, whose last includes the resection (elimination) of the fistula.and the surrounding fabric as affected organs.
Fistulotomy is contraindicated for the treatment of the complex fistula.
These include those found in the anal sphincter (where more muscles) have several holes, or are the result of local radiotherapy or (IBD) . The front sweets (front) in women, as a general rule, with the participation of vaginal tissues are also considered complex.
Since vulnerable fabrics are associated with these types of fistula, there is a significant risk of reconciliation and incontinence to feces A> (inability to control the intestine movements).
For the same reasons, fixedotomy prevents people with recurrent dates or those with a previously existing fecal incontinence.
In accordance with the revision 2020 in ARDETS coltorology Recreators Sophisticated fistulotomy is up to 21%,In time as the risk of incontinence of feces (from soft to heavy) is up to 82%.
As in all surgical procedures, fistulotomy represents the risk of injury and complications.Some of them can occur immediately after the procedure, while others can develop in a few weeks.
Early complications of the Fijstulotomy include:
Delays of complications occur less common,But they may include:
- recurrences recurrences
- incontinence incontinence
- anal stenosis (year of narrowing, earn more difficult to pass the chair)
- The healing delay of the wound (wound,that is still insanomic after 12 weeks)
The purpose of the Fijstulotomy Espara delete the pus and the liquid,Susperate tissues that allow them to be treated when closing an abnormal opening between the roads. The intention of surgery is to minimize the damage (or cut) the anal sphincter to save the function of the sphincter.
Fistulotomy can be used more than 50% of fistula cases. And when used accordingly, the operation can offer the treatment rate close to 100% in accordance with the 2018 analysis in the international magazine .
Decision about the treatment
Fiustulotomy guide First first, the procedure is considered for the surface fistulas located between the internal and external anal sphincters.These types of fistulas can generally be considered quickly and effectively in the office procedure.
Large physteites that have grown in deeper tissues can be processed in the operating room, but other options can be considered.This is due to the fact that an additional procedure called sphincterroproplasty may be required to restore the sphincter after fistutym. This is a technically difficult operation that many surgical centers do not offer.
Instead, other established procedures, such as Seton (method used to create a temporary drainage channel), and then operations to close the Opening (with concurrent electric,Laser surgery or biological adhesives) may be preferable.
criteria to select
To determine if the fistulotomy is the health care provider will perform a digital rectal exam with a finger stuck to evaluate the size and location of thefistula.al Run Gastonroglog, a digital exam may be necessary to create an initial diagnosis.
Other tests will be asked for an accurate exact position and the fistula path, which includes:
- x-Ray with a contrast in Baria : During this test, the barium solution swallows or is administered as an enema to help determine any X-ray anomaly.
- Magnetic resonance display (MRI) : This display test uses powerful magnetic and radio waves to create very detailed cloth images.Even more efficiently to visualize soft tissues, that radiography or ct scan .
- endoscopic ultrasound : This includes an insertion of a narrow converter in anus and intestine to generate images of internal structures using high frequency sound waves.
- Fistulography: In this test, the contrast is entered through the outer hole of the fistula to display its size and route to the radiography.
- Bottom endoscopy : This includes the introduction of flexible fibrous volume (called endoscope) in the anus and intestine to the tissues of the image.
These tests can help direct how fipulotomy approaches and determines whether other surgical procedures should be considered.
How to cook
When determining that the phystulotomy is adequate, the destination will be scheduled to perform the operation.Less complex cases can be processed by a gastroenterologist, a general interpartise A at a , which has suffered additional training in the gastrointestinal tract.
If you mention a surgeon for the procedure, a separate purpose will be scheduled to consider conclusions and analyze the operation of preparation for recovery.Fistulotomy can be done by colorectal colorectal colorectal , also known as a proctologist, which is certified on board in general surgery and has suffered additional training in the Colon team and rectal surgery.
Depending on the size and location of the fistula, the Fíritus It can be done in the hospital, the surgical center or the Gastroenterologist Office.
What to use
, as you need to change in the hospital dress, use something weakened and comfortable that you can delete and Return easily. Leave anything valuable at home, including hours and jewelry.Keep in mind that you will be asked to eliminate contact lenses, dentures, hearing aids and piercing before the operation.
After completing the procedure, the nurse will provide sanitary pillows in underwear, if there is bleeding.
Food and beverages
You must stop going at midnight for the night before the operation.Up to four hours before the procedure, you can drink a small amount of water to take any tablet in the morning (if approved by your surgeon). During four hours, you can not drink or eat anything, including rubber chips or ice.
Although intestinal preparation is not required for the fisetomy, some health care providers recommend using a single enema in the morning of the procedure to help clean the intestine of Any fecal residue.
Your health care provider will advise you to stop taking certain medications that can promote bleeding and slow healing.Some may have to be detained for one or several days before the procedure, while others can be temporarily detained during recovery. Anxiety preparations generally include: Your healthcare provider may also recommend that you stop smoking for a week or two after surgery.Smoking causes a narrowing of blood vessels and can reduce healing, reducing the amount of oxygen reaches the wound.
Your health care provider will advise you to stop taking certain medications that can promote bleeding and slow healing.Some may have to be detained for one or several days before the procedure, while others can be temporarily detained during recovery.
Anxiety preparations generally include:
Your healthcare provider may also recommend that you stop smoking for a week or two after surgery.Smoking causes a narrowing of blood vessels and can reduce healing, reducing the amount of oxygen reaches the wound.
What to do
Be sure to take your Certificate of controller (or another form of the status identity card), the insurance card and the approved payment method, if the institution requires the payment prior to its surcharge, .
You will also have to bring someone with you to take it home. Even if the total anesthesia is not used, it will almost invariably be too large and uncomfortable to control safely.
What to expect on the surgery day
Regardless of whether your procedure is in the hands of a gastroenterologist or colorectal surgeon,Your health care provider will be accompanied by an operational nurse and, in most cases, anesthesiologist .
Before the operation
As soon as it is proven and signed the necessary forms of consent, accompany the Back to change to a hospital dress.After it is verified by vital signs , the intravenous line (IV) in the vein will be inserted to deliver drugs and liquids in your hand.
Anesthesiologist will also meet with you to discuss drug allergies you have and have adverse reactions to anesthesia in the past. An anesthesiologist should also advise what kind of anesthesia is used and why.
During the operation
however, if the fistula is small and is next to the surface of the skin, local anesthesia supplied by injection to help curse the site, maybe everything that Need.In such cases, the anesthesiologist may not be necessary.
preliminary efficiency antibiotics will be delivered through line IV to help cure and help prevent infection.
Depending on the location and position of the fistula, it can be placed in one of the three positions:
- position lying : face down flat table
- position position : face down on a v-Investillate form in the ‘jacknof’ position
- Lithotomy position : Lying on the back of the knees and calves in the high stirrups in 90-Standard grade
During Fijstulotomy, the health provider will take a cut to open An abnormal hole between two structures. The anal retractor gently opens the anus, while the fistula itself cut scalpel.Each effort will be made to avoid or limit the damage to anal sphincters.
After opening, the base of the wound is cured (scrap). Then, the wound is left open to cure independently.The need for marking (in which cuts the edges of wound wounds) can be used to promote drainage, reduced bleeding and guarantee better pain in more.
Finally, the wound is packed or covered with gauze, and is sold to help you.
Fijstulotome can be taken from where 30 minutes to an hour, depending on the size and location of the fistula.
After the operation
After surgery, it takes to the recovery room and is controlled until He wakes up completely. Food and beverages can be administered, as well as anti-nauseous products , if you feel nausea.Often, he experiences rectal pain and discomfort immediately after Fijstulotomy, even if local anesthesia was used.
As soon as you are stable enough to go and go to your clothes, the nurse will send you a house with patients with antibiotics, sanitary pads or diapers and instructions for caring for wounds.Friends or family members will have to drive it to your home and ideally stay with you at night to control complications.
Regardless of the type of anesthesia used,You must relax for the rest of the day when I return home. Do not bathe or bathe during the first day. To reduce discomfort, lie on your side when relaxing or sleeping, put loose clothing and underwear and limit the number of rides you perform.After that,
, wait a week or two recovery, which includes controlling wounds, pain control, changes in the diet and restriction of physical activity.
With adequate care, most people can return to work and normal activity ranging from one to two weeks of elevulotomy.
Your health care provider will provide you with instructions on frequency with the frequency. You need change the refueling to your wound .In the first days, you may need to do it up to four times a day, carefully packed the wound of sterile gauze to absorb any liquid or blood. After that, the bandage can usually be changed per day.
You may be provided with a topical antibiotic for use in the initial stages of healing, as well as oral antibiotics that you must accept as specified and before completion.
During recovery, it is important to avoid intense physical activity, severe elevation or positions, such as deep food, which can open the wound.It also helps to sit on soft pillows or donut-shaped pillows (available on the Internet or many pharmacies) to reduce pressure on the wound.
It is important to keep in mind that even adequate attention, you can sometimes produce complications of physical surgery.
When you call a medical care provider
call your surgeon immediately, if you experience any of the following once the triplicity passes:
- Heavy uncontrolled bleeding
- Increased pain,Redness, edema or discharge in the surgical area
- high temperature (more than 100.5 f) with cold difficulties
- or disability to urinate
- constipation of more than three days
- nausea and vomiting
People often care about theIntestinal movements during raising the fistulaosurvía, which can not only be painful, but it is difficult to clean.To relieve pain during intestinal movements, it eats the diet rich in the fiber and use the laxative or stool stoule , prescribed by its surgeon.
After the intestinal movement, you can clean the wound, washing it with warm water, a sneaker of the peri bottle.Once you are rinsed completely, you can write the clean area with the child’s cleaning or gently clean the skin with Marley cotton bath, sitting in the Sitz bath.(Avoid adding hydrogen peroxide, flavors, homeopathic tools or water-based alcohol products, as it can decrease the speed.After washing, the poetham, and not dry skin, in addition, you can use the hair dryer installed in the lowest configuration (both temperatures and forces) to keep the skin dry carefully.
Pain is usually controlled with a pain revaluation Overcome, such as Tylenol (acetaminophen) and / or current anesthetic, such as lidocaine. Fifteen Minute Sitz Baths can also help.
If the pain is especially heavy, your health care provider can assign an analgseicher opioid, such as vicodin (hydrocodone) , but usually only a few days to avoid dependence .
Care for Attention is the key to long-term recovery and health.In some cases, your surgeon can schedule a subsequent visit per day or two after surgery if the wound is large or the procedure was extensive. If the fistula was relatively simple, you can only see the surgeon after three to four weeks.
Fistulotomy is extremely effective to solve ordinary perianovsky fistula. If the fistula is treated without complications, it will not generally not return or require constant medical attention.
Word of the Meds information received
If you think you have a fistula, but I’m not sure, it is important to review gastroenterologist.Signs include sitting pulsating pains or having a bowel movement, swelling and redness around the anus and driving blood or pus when you correct.Only research from the health care provider can confirm if it has fistula and directs it to the appropriate treatment.