Contents
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 10% guarantee of a successful outcome. So, about XNUMX% 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 that you immediately sign up for a consultation with a proctologist if you find profile symptoms.
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 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 date will be announced by the surgeon, 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, the conclusion of a gynecologist, a therapist. 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 fiber and causing increased gas formation. These include:
- raw vegetables and fruits;
- black bread;
- legumes;
- sweets;
- pure milk;
- carbonated drinks.
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:
- general serious condition;
- infectious lesions in the peak period;
- decompensation of a chronic illness;
- problems with blood coagulability;
- kidney failure;
- liver failure.
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.
At the same time, 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;
- ischial-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 boiled in water;
- 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 potatoes and beets;
- fermented milk products;
- fruit puree and baked apples.
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 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.