Anal fistulotomy and fistulectomy




A Anal fistulotomy and fistulectomy




1. Introduction

Most perianal fistulas arise as a result of infection within the anal glands located at the dentate line (cryptoglandular fistula). Fistulas may also arise as the result of trauma, Crohn’s disease, inflammatory processes within the peritoneal cavity, neoplasms, or radiation therapy. The ultimate treatment is determined by the cause and the anatomic course of the fistula and can include fistulotomy and fistulectomy. The primary goal is palliation, specifically to drain abscesses and prevent their recurrence. This is often accomplished by placing a Silastic seton (a ligature placed around the sphincter muscles) around the fistula tract and leaving it in place indefinitely. In the absence of active Crohn’s disease in the rectum, attempts at fistula cure may be undertaken.



2. Preoperative assessment
a) History and physical examination
(1) Respiratory: A careful evaluation of respiratory status is important. If the patient has significant respiratory disease, the lithotomy position is better tolerated than the prone or jackknife positions.

(2) Musculoskeletal: Pain is likely at the surgical site and should be considered when positioning the patient for anesthetic induction. (If the patient has pain while sitting, regional anesthesia should be performed with the patient in the lateral decubitus position.)

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Dec 2, 2016 | Posted by in ANESTHESIA | Comments Off on Anal fistulotomy and fistulectomy

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