Postoperative fistula: features of healing and treatment. Removal of the fistula of the rectum and the rehabilitation period Discharge after removal of the fistula

A rectal fistula is a channel that has formed between the rectum and the skin or fatty tissue surrounding the organ. The most common cause of pathology is chronic paraproctitis, an inflammatory process in the fatty tissue around the rectum, as a result of which an abscess is formed, and a canal remains in its place.

What are rectal fistulas?

There are 3 varieties:

• Transsphincteric.
• Intrasphincteric.
• Extrasphincteric.

Additionally, a division into complete, incomplete, simple and complex fistulas is carried out. They differ in the number of passages, inlets and branches.

Depending on the category of complexity - 106,000 - 140,000 rubles.

Included in the price:

surgery, anesthesia, dressings, medicines, food and hospital stay

30-40 minutes

(duration of procedure)

2-3 days in hospital

Indications

The only indication for surgical intervention is the complete absence of results with conservative treatment. Often patients cannot get rid of the pathology for several years. The fistula closes and opens, which is accompanied by pain due to the inflammatory process.

Contraindications

A contraindication to surgery is a rehabilitation period of less than 8 months after the treatment of acute paraproctitis. It is impossible to allow the development of a fistula and the growth of scar tissue, so you need to be regularly observed by a proctologist (otherwise it will complicate surgical intervention). It is not recommended to perform the operation in case of intolerance to anti-inflammatory drugs, local and spinal anesthesia.

Symptoms and diagnosis of a fistula

There may be pain of varying intensity. Such periods of exacerbations and improvement of the condition constantly alternate. Periodically, there is a blockage, accumulation of pus and a deterioration in the patient's condition with increased pain, a violation of the general condition and an increase in the temperature of the patient. Then the fistula is opened, the pus flows out, the condition returns to normal. But self-healing never occurs.

Diagnostics

The following methods are used to diagnose the disease:

• Proctologist examination. Finger examination of the rectum, probing of the fistulous tract, dye test.
• Anoscopy.
• Sigmoidoscopy (for the diagnosis of concomitant diseases of the rectum and sigmoid colon).
• Colonoscopy (to clarify the diagnosis, exclude inflammatory bowel diseases).
• Ultrasound transrectal examination (to clarify the location of the fistulous tract, identify streaks and cavities).
• Computed and magnetic resonance imaging of the pelvis and perineum.

The modern diagnostic equipment of the CELT clinic makes it possible to conduct a full examination and establish the position of the fistula.

It is important for the patient to know

• The presence of a fistula of the rectum is an indication for surgical treatment.
• The choice of operation depends on the complexity of the fistula, determined by the course of the fistula in relation to the muscles of the anus and the prevalence of the purulent-inflammatory process in the pararectal tissue.

What tactics in the presence of a fistula of the rectum

During defecation, the damaged soft tissues become infected with pathogenic bacteria contained in the feces. This regularly causes exacerbations and translates the pathology into a chronic form. Over time, a person cannot work normally and be in a team, because pads cannot completely contain pus and feces. This causes bad breath and discomfort. Additionally, immunity falls, which in the fair sex can provoke the progression of colpitis.

With the development of pathology, scar tissue grows in the sphincter zone, which causes gas and fecal incontinence. With an exacerbation, body temperature rises, and symptoms of intoxication appear.

The disease does not go away with time, but only worsens. In the last stages, the development of a malignant tumor is possible. Therefore, there is only one way to get rid of the pathology - to remove the affected tissues and prevent the growth of bacteria and the inflammatory process.

Operation types

With transsphincteric and intrasphincteric fistulas, the purulent part is opened and completely cleaned. A gauze swab soaked in a healing ointment is inserted into the wound. At the end of the procedure, the surgeon inserts a gas tube into the colon.

Removal of extrasphincteric fistulas takes more time, because they have a lot of branches and are longer. Surgeons use the ligature method. An excision is performed and a thread is introduced into the inner zone, which passes outward through the fistula. Next, the ligature is tightly tightened along the front, middle or back of the anus.

Minimally invasive methods show high efficiency in simple fistulas. This is laser burning, the introduction of a therapeutic biotransplant or fibrin glue.

Preparing for a fistula removal operation

Before surgery is carried out:

• Computed tomography of the pelvic organs.
• X-ray examination of the fistula with a contrast agent.
• Sigmoidoscopy.
• EKG.
• Fluorography.
• Biochemical and general examination of blood and urine.
• Consultation of a therapist, proctologist and gynecologist.
• Culture of fistula discharge to test sensitivity to antibiotics.

In the presence of chronic diseases, improvement must be achieved in order to normalize the functioning of the cardiovascular and respiratory systems. Additionally, the specialist prescribes washing with antiseptic agents and taking antibiotics after sowing purulent fistulous discharge.

For 3 days before the procedure, you can not eat products that enhance gas formation. In the evening and in the morning before the operation, an enema is performed for deep cleansing of the intestines (laxatives are prescribed in case of difficulties). It is mandatory to remove hair in the perineal area.

Surgical treatment of rectal fistulas

Treatment of fistulas of the rectum is carried out only by surgical methods. Healing cannot occur on its own or under the influence of medications.

Usually, treatment is prescribed during an exacerbation, since the fistula is detected quite easily along the entire length. The surgeon opens the abscess, rinses it with antiseptic solutions. The patient is prescribed antibiotics. After that, the fistula is removed. This is done in various ways, depending on the location and length of the fistula. Treatment is carried out in a hospital.

Postoperative period

Within 2 weeks, the patient spends time in the hospital with strict adherence to bed rest. Antibiotics are being taken to prevent the spread of infection. Avoid bowel movements for at least 5 days. Specialists slow down peristalsis with a special diet and therapeutic agents. Dressing is carried out after 3 days. Tampons soaked in therapeutic ointment and hydrogen peroxide are introduced. Anesthesia is performed first. If a bowel movement does not occur after 5 days, an enema is given.

It is important to strictly follow the diet during the entire period of rehabilitation. It is allowed to use pure water, boiled vegetables, scrambled eggs, semolina porridge without adding milk. You can not eat raw fruits and vegetables, as well as drink alcohol. After defecation, the colon is treated with chlorhexidine. The sutures are removed by the surgeon after a week. Tissue regeneration can take a maximum of 21 days. It is recommended to perform therapeutic exercises to avoid weakening the muscles of the anus and incontinence.

Possible Complications

• Injuries of the urethra.
• Reappearance of a fistula.
• Accumulation of pus in the area of ​​operation.
• Severe bleeding during and after surgery.
• Weakening of the muscles of the anus and incontinence.

The incidence of complications with correct excision of the fistula in the hospital is less than 10%.

Why do patients choose CELT for the treatment of rectal fistulas?

• For the treatment of rectal fistulas, there are more than 100 different surgical interventions. The CELT clinic employs proctologists with extensive experience, who are proficient in all types of operations for rectal fistulas.
• The clinic guarantees not only high-quality treatment and anesthesia, but also a comfortable stay without pain in the postoperative period.
• After the operation, the patient stays in the hospital for an average of 2-3 days. In the clinic, the patient is observed until complete recovery.

Excision of the fistula of the anus is an operation that involves not only the elimination of the fistulous passage, but also the affected anal crypt. The operation algorithm is developed individually in each clinical case. A fistula of the rectum is an abnormal passage (fistula) formed against the background of a chronic process that occurs in the walls of the intestine and nearby tissues. Currently, almost all authors agree on a single classification of rectal fistulas:

• full - open on one side on the mucous membrane of the rectum, and on the other hand - with one or more holes in the skin;
• incomplete - open only on the mucous membrane or only on the skin.

In most cases (in 90%), paraproctitis becomes the cause of the formation of fistulas. Also, pararectal fistula may be the result of the following pathological conditions:

• haemorrhoids;
• anal fissure;
• rectal diverticula;
• Crohn's disease;
• tumor or tuberculosis of the rectum;
• infectious and inflammatory processes of the large intestine;
• mechanical trauma to the anal canal.

Fistula treatment is only surgical. The main task of the operation is to eliminate the fistulous tract, including internal and external outlets, clean the purulent cavities, excise all altered tissues, including the affected crypt, and restore the normal anatomy of the intestine.

When the first symptoms of the disease appear, sign up for a consultation with a proctologist surgeon. The choice of treatment method depends on the nature of the pathology, location, form, and other factors.

Why surgery is needed

A fistulous tract is a passage between the intestine and the skin around the anus, formed against the background of a purulent process. Outwardly, it is a small narrow channel lined with epithelium, having an entrance and exit in the form of a non-healing wound with compacted edges. Even after the acute infectious-inflammatory process subsides, the abnormal channel does not close. An unpleasantly smelling ichor or pus is constantly or periodically released from the wound, which provokes irritation of the surrounding tissues, soreness and redness of the skin.

In addition, the long existence of fistulas leads to deformation of the anus, cicatricial changes and other complications. Conservative treatment can temporarily relieve pain, but not eliminate the cause of the pathology. Only an operation can cope with such a task.

When to See a Coloproctologist

A direct indication for surgical intervention is a diagnosed fistula of the rectum. Pathology is accompanied by the following symptoms:

• the appearance of a non-healing wound in the anus;
• discharge from the fistulous course of ichor, pus;
• bad smell;
• pain, irritation, redness of the skin around the wound;

• violation of defecation and urination;
• redness and induration around the anus;
• pain during emptying;
• discomfort in the anus when sitting, walking and physical exertion in the anus;
• general weakness.

If such symptoms occur, do not delay contacting a doctor, because a rectal fistula is a serious pathology that, without adequate treatment, leads to severe complications, up to malignancy (malignancy).

The cost of excision of the fistula of the rectum

The prices indicated in the price list may differ from the actual ones. Please check the current cost by calling +7 495 104 8605 (24/7) or at the GMS Hospital at: Moscow, st. Kalanchevskaya, 45.

The price list is not a public offer. Services are provided only on the basis of a concluded contract.

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Rectal fistula excision at GMS clinic

At the GMS clinic, rectal fistula excision is performed by experienced coloproctologists using general or epidural (spinal) anesthesia. The use of modern surgical units provides the following advantages:

• bloodlessness of the intervention;
• minimal surgical trauma of the obturator canal of the rectum;
• fast healing;

• absence of postoperative edema, inflammation;
• painlessness of the procedure;
• short recovery period;
• short hospital stay.

Experienced GMS coloproctologists, using minimally invasive innovative treatment methods, help to successfully get rid of rectal fistula at different stages. The clinic performs all types of operations for excision of the fistula of the rectum using modern equipment. Make an appointment with our specialist by phone or online to receive quality medical services.

Preparation, diagnostics

Often the diagnosis of pathology is not particularly difficult. Already during the initial examination, the proctologist establishes a diagnosis, determines the location of the fistula, its structure, building up the tactics of treatment. A comprehensive examination also includes:

• probing the pathological channel to determine its structure;
• if necessary, colonoscopy or sigmoidoscopy;
• Ultrasound or MRI of the anorectal region;
• according to indications - fistulography.

In some cases, other methods of research may be required to clarify the diagnosis. The tactics of intervention is determined by the coloproctologist based on the results of the examination and the data obtained during the examination.

Before the operation, you will need to do a chest x-ray or fluorography, ECG, blood and urine tests. It is possible to undergo a preoperative examination at GMS Hospital in 1 day. Preparation also includes the following steps:

1. a week before the operation, exclude alcohol, do not smoke, drink or eat in the morning on the day of the procedure;
2. 2-3 days before the intervention, exclude from the diet foods that promote constipation and flatulence (slag-free diet);
3. the last meal should be no less than 8-10 hours before the operation;
4. cleansing enema or bowel preparation with Fortrans.

How is the operation performed

Excision of rectal fistulas is performed using various techniques - from the Gabriel operation to the LIFT operation.

Radical treatment of this fistula involves performing an operation that removes the fistulous tract and the inflamed anal crypt, which is a constant source of infection.

However, such operations are carried out only in a planned manner, and emergency cases and decompensated concomitant diseases are indications for a primary operation involving the opening and sanitation of a purulent cavity.

The term for performing a radical operation, which involves the complete removal of the focus of infection in the adrectal tissue, depends on the individual characteristics of the clinical course of the disease and the patient's concomitant health problems. If the process is in the acute phase, there are purulent infiltrates and abscess formation, they are first opened and carefully sanitized, and then the inflammation is eliminated by conservative measures and local antibiotic therapy. Only after complete relief of inflammation is the question of a radical operation for excision of the fistula and complete removal of the purulent focus resolved.

Types of operations used for radical treatment of rectal fistula:

• dissection of the fistulous tract into the lumen of the anal canal;
• Gabriel's operation;
• excision followed by drainage to the outside;
• excision followed by suturing tightly;
• tightening with a ligature;
• plastic method;
• LIFT operation.

Dissection into the lumen of the anal canal is a technically simple method, but it has significant drawbacks. After such a dissection, the wound above the fistula sometimes closes too quickly and conditions for recurrence remain. In addition, after such surgery, the integrity of the outer part of the anal sphincter may be violated.

Gabriel's operation consists in excision of the fistulous tract from the external opening to the bottom of the purulent cavity using a probe inserted into its lumen. After that, the skin adjacent to the fistula and all other adjacent tissues affected by inflammation are excised. In the case of a single fistulous tract without cicatricial changes around after its excision, the remaining cavity can be sutured tightly. If there is no certainty that inflammation does not spread to neighboring tissues, then after its removal, drainage is left for several days.

Ligature method - used for high extrasphincteric fistulas. In this case, the ligature is inserted through the bottom of the purulent cavity through the fistulous tract, and then both ends are removed from the rectum to the outside and tied.

Plastic method - involves, after excision of the fistulous tract and removal of purulent streaks, cutting off the muco-muscular flap and moving it in order to close the fistula. The prognosis for the treatment of fistulas is favorable only after radical operations. As a rule, after such treatment comes a complete recovery.

The LIFT operation is a modern microsurgical technique - ligation of the fistula in the intersphincter space, which allows you to guarantee the function of the anal sphincter and reliably eliminate the fistula. To perform this operation, one very small (no more than 1-2 cm) incision is made outside the anus, through which, with the help of special tools, it is possible to isolate, cut and suture the fistulous tract at its very beginning, in the area where the anal glands are located. Thus, the primary focus of infection is eliminated. The muscles of the anus remain unaffected.

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Fistula of the rectum refers to diseases that do not pose a great danger to the body. However, the disease is unpleasant, knocking the patient out of the usual rhythm of life. In case of illness, a hole (fistula) opens into a hollow organ or directly outward, through which pus, mucus comes out. Surgery will be required to remove the fistula. The cause of the problem lies in the development of fiber diseases.

If it happens, after the operation, recovery plays an important role. It is necessary to go through all the prescribed procedures, examinations so that the disease does not start to progress again. About 80% of patients are men. Accelerate the development of fistula anal fissures, hemorrhoids. Another reason is prolonged diarrhea after surgery.

Fistula of the rectum (rectal fistula) has the following varieties:

• Full, with 2 holes. One is open to the intestines, the second - to the outer part, near the anus.
• Incomplete that open in one direction only. They can be internal or external. They develop mainly after the removal of tumors, intestinal tuberculosis, unprofessional biopsy. Damage to the walls of the gastrointestinal tract leads to the spread of intestinal bacteria into the pararectal cavity.

A person can diagnose the disease if he finds pus, or feels discomfort in the perianal zone. Wounds sometimes secrete pus, cloudy blood. You have to constantly change linen dirty in the blood, use moisture-absorbing products, and perform hygiene of the perineum. With strong discharge, irritation of the skin occurs. Constant itching, an unpleasant odor are the first symptoms of a fistula.

The rectilinear fistula is quickly eliminated. Severe pain does not appear. Incomplete fistulas cause regular discomfort due to the chronic course. With any sudden movement, the symptoms are aggravated. Blockage of the fistula channel threatens to increase the amount of pus. Exacerbations, abscesses, fever, intoxication due to accumulation of pus are possible.

Symptoms

The following symptoms occur:

• weakness, lack of sleep;
• decrease in concentration;
• an increase in body temperature during certain periods (often at night);
• nervousness.

Recovery after surgery should be carried out under the supervision of a professional. With a long absence of treatment, incorrect methods used after surgery, serious changes are possible. The anus is deformed, scars form on the sphincter muscles.

Treatment of rectal fistulas

Prior to the surgical operation, which is the main method of getting rid of the fistula of the rectum, additional treatment may be prescribed. Antibiotics, painkillers, healing substances are used. Medications are taken to improve the condition, but most often such therapy does not bring significant relief.

Physiotherapy may be prescribed in preparation for the operation. The need for physiological procedures is to reduce the risk of complications after the surgeon's actions.

It is not necessary to treat a fistula with folk methods. Substances used may provide temporary relief. It is unlikely that they will be able to do something with their help, but time will be lost.

Remove rectal fistula is the only solution to the problem. Specialists do not treat in remission. The fistulous passages are closed, the pus stops oozing, it is difficult to determine the site of the operation. The surgeon can partially remove the problem area, touch the healthy part of the digestive system.

The type of fistula determines the pathogen removal technique. The size of diseased areas, the rate of pus release affect the methods used. The surgeon needs to correctly cut off the fistula, drain the purulent canals, if necessary, sew up the sphincter, and close the damaged cavities.

The steps are different in each case. The use of general anesthesia is mandatory, the patient is under the supervision of a doctor for about 10 days.

Features of the postoperative period

It takes time for the complete healing of the damaged cavity, fistulous passages. Stages of the postoperative period are divided into inpatient and outpatient.

The first part of the recovery - the patient is placed in a hospital under observation. A tube is installed that removes gases, analgesic drugs, antibiotics are prescribed. Bandaging is carried out several times a day.

Eating is allowed 12 hours after the operation., necessarily finely ground. Frequent fluid intake is recommended. In 90% of cases, baths are prescribed, in which an antiseptic solution is added, ointments for pain relief. If necessary, laxatives, other required substances. In the hospital, the patient is delayed for the time required for partial restoration of functions, wound healing.

outpatient period

• The fistula heals for a long time, the discharge does not stop for 3 to 5 weeks. It is recommended that at the end of the outpatient period, leaving the hospital, do not stop taking sitz baths. Carry out procedures in the morning and evening with the addition of prescribed medicinal infusions, antiseptic preparations. The wound should be covered with sterile bandages, lubricated with disinfecting ointments. Baths are also taken after the next bowel movement.

A mandatory measure, if the rectum is prone to disease, is a diet. The patient consumes the required amount of liquid to soften the feces, fiber. Spicy foods, alcohol are excluded. It is not recommended to be in a sitting / standing position for a long time. It is forbidden to perform heavy physical work, lifting any heavy objects.

• Any violation of the regime provokes the opening of the wound, prolonged healing. Recommendations are described by the attending physician - proctologist.
• After some time (usually a day), the patient is allowed to drink water. After anesthesia, there are unusual sensations in the body, sometimes severe pain. The first few days the patient drinks a course of painkillers.
• After the first dressing, they are removed. Bandaging is a painful procedure for the patient. Mandatory preparations of local action on the body. The attending physician controls the healing: the edges of the wound should not stick together, no suppuration should accumulate, no drainable pockets.
• If the operation was complicated, after a few days there is a need for dressing under anesthesia. A deep processing of the site of the operation is done, the ligature is tightened. To heal the wound faster, baths with potassium permanganate or chamomile are performed.

Diet after removal of the fistula of the rectum

After the operation, it is necessary to use not only medicines that accelerate the healing of the resulting wound, but also other methods. Diet helps the body cope with damage. It is necessary to eat food rich in vitamins, nutrients, so that recovery goes faster. Food is divided into small portions, consumed evenly. Products should not adversely affect the stomach, promote flatulence, constipation.

It is advisable to avoid bowel movements for the first 20 hours after the operation. The patient must fast for several hours. After the second day you can eat. Products are steamed or baked. Vegetables are used in any form. The following foods are allowed:

• Bread made with wholemeal flour or wheat.
• Baking, drying (not rich).
• Soups on the broth of meat, vegetables. Necessarily light, without the addition of numerous seasonings. You can eat cold dishes: beetroot, fruit or vegetable soups.

• Lean meats. The product must be boiled or baked.
• Fish, only sea. Definitely boiled or stewed.

• Premium sausage, milk sausages.
• Vegetable dishes, snacks. Greens are used processed or raw, fermented.
• Porridges, which are a source of useful components. Most often, try to eat buckwheat, rich in carbohydrates that energize the body.
• Useful baked, boiled pasta.
• Green peas and bean curd.

• Eggs are consumed boiled, preferably as part of other dishes.
• Low fat dairy products.

There is a list of products prohibited for consumption in the postoperative period. These include any dishes or components that increase blood flow to the pelvis. The prohibited category includes:

• alcoholic beverages, preservatives, smoked meats;
• complex proteins and dishes based on them (goose, lamb, pork meat);
• mushrooms, which are difficult to digest food;
• products that enhance the process of gas formation in the esophagus can be consumed, but in limited quantities;
• pastries, pastries, cakes;
• high-fiber fruits, garlic, onions, spinach;
• legumes, peas, beans, whole milk;
• fried meals.

If you follow the rules of dietary nutrition, recovery will be significantly accelerated. Proper nutrition helps to remove the complications that arise when unwanted substances enter the body that slow down the healing process.

Prevention

As a preventive measure, so that the disease does not recur, the timely treatment of paraproctitis plays an important role. It is important to completely get rid of the factors leading to injuries of the rectum. Preventive methods of dealing with the fistula of the rectum:

• Timely treatment of diseases of the rectum. It is necessary to heal anal fissures, to prevent the progression of hemorrhoids.
• Timely disposal of diseases, a symptom of which is itching. Prevention of irritation of the skin around the anus. It is important to diagnose and eliminate colitis, diabetes, invasion and other similar diseases so that the development of extraneous problems does not happen.
• Proper nutrition. Digestive organs directly affect the occurrence of fistula. Constipation, diarrhea are the first digestive disorders leading to the development of pathology.
• Being in a suitable temperature zone. Hypothermia of the organs increases the likelihood of the onset of the disease.
• Hardening of the body and personal hygiene.

Subject to the above recommendations, the likelihood of a fistula of the rectum is significantly reduced, its excision is not required. If symptoms of the disease are detected, you should consult a doctor to diagnose disorders at an early stage.

To alleviate the patient's condition in the presence of a fistula in the pararectal tissue, excision of the fistula of the rectum is prescribed. The tactics of surgical treatment is selected depending on the type of violation. If surgery is contraindicated, conservative therapy is performed, which is not able to completely get rid of the disease. A neglected pathology causes serious complications.

The formation of fistulas is an unnatural phenomenon, which must be disposed of in time. Intestinal fistulas are openings where feces penetrate, provoking infection of the soft tissues.

As you know, acute paraproctitis, leaving behind purulent foci, leads to the formation of a pararectal fistula. A third of patients who have paraproctitis are in no hurry to be treated. In some cases, abscesses open spontaneously. However, without treatment, the disease becomes chronic, accompanied by appropriate symptoms.

Also, rectal fistulas can occur after operations, such as gastric fistula.

• intense pain;
• hyperemia;
• intoxication;
• edema.

Intestinal fistulas of a chronic form have a different symptomatology. There is an alternation of remission and exacerbation, while the affected area itches and there are discharges in the form of pus, ichor and feces.

The longer the pararectal fistula progresses, the more difficult the operation will be. In addition, the risk of malignancy of the fistula increases.

A huge mistake is made by those who hope for the self-elimination of the pathological hole or for its cure with the help of folk remedies. Only one treatment of a fistula of the rectum, that is, chronic paraproctitis, will be effective - surgical, because in order to heal the fistula, it is necessary to excise the scar tissue that surrounds the cavity.

On an emergency basis, patients with exacerbation of chronic fistula are operated on.

An operation to remove a fistula formed in the rectal area is performed using general or epidural anesthesia, because the muscles must be completely relaxed.

Despite the fact that surgery has reached great heights in its development, the treatment of fistulous tracts remains one of the most difficult.

• dissection of the fistula;
• excision of the pathological canal along its entire length, while either draining to the outside or suturing the wound is performed;
• tightening the ligature;
• excision with subsequent plasty of the existing stroke;
• laser cauterization;
• radio wave method;
• canal filling with various biomaterials.

The simplest in terms of execution technique is dissection. But among its shortcomings, it is necessary to name too rapid closure of the wound, the preservation of conditions for the reappearance of the pathology, as well as a violation of the integrity of the sphincter from the outside.

In the presence of transsphincteric and intrasphincteric fistulas, a wedge-shaped excision is performed, while skin and fiber are removed. Sometimes the sphincter muscles are sutured. The intrasphincteric fistula is the easiest to remove due to its proximity to the anus.

If there are purulent accumulations along the canal, it must be opened, cleaned and drained. Wound plugging is carried out using a gauze swab treated with Levomekol or Levosin. In addition, the use of a gas outlet tube is provided.

If paraproctitis caused the formation of extrasphincteric fistulous passages, then the presence of rather extended channels with multiple branches and purulent cavities is implied.

The task of the surgeon is to:

• resection of the fistula and cavities with pus;
• elimination of the connection of the fistula with the anal canal;
• reducing to a minimum the number of manipulations on the sphincter.

1. After removal of the fistula of the rectum, a silk thread is inserted into the hole, which is subsequently removed from the other end of the canal.
2. The place of laying the ligature is the middle line of the anus, because of which the incision can sometimes be extended.
3. The ligature is tied so that it tightly clasps the muscle layer of the anus.

With each dressing that will be carried out in the postoperative period, the ligature will need to be tightened until the moment when the eruption of the muscle layer can be fully achieved. So you can avoid the development of insufficiency of the sphincter.

The plastic method is an operation to excise the fistula and extract accumulations of pus in the rectal area, followed by closing the fistula with a mucosal flap.

Treatment of fistulas in the intestine is possible with the use of biotransplants. The agent placed in the pathological hole contributes to the fact that the fistula begins to germinate with healthy tissues and, accordingly, heals.

Sometimes they resort to the use of fibrin glue, which close up the fistulous tract.

Recently, doctors are increasingly using a laser to get rid of fistulas. In other words, the fistula is simply burned out.

• no need to make large incisions;
• no need for stitches;
• the operation takes place with minimal blood loss;
• the recovery period lasts much less and is almost painless.

Laser cauterization is indicated for patients in whom paraproctitis provoked the appearance of simple fistulas. If there are branches and purulent channels, the technique is chosen differently.

A sufficiently effective and safe method is radio wave treatment, in which there is no mechanical destruction of the tissue. Such surgical intervention provides for a non-contact method of exposure.

• the absence of blood loss, because when the tissues come into contact with the electrodes, coagulation of the vessels occurs;
• minimal trauma (the wound does not need to be sutured);
• minor postoperative consequences compared to other methods (the risk of infection is minimal, there are no scars and deformation of the anus);
• speedy recovery.

When the fistula of the rectum was removed, after the operation it is necessary to stay in bed for several days. The patient must take antibiotics for approximately 10 days.

In the postoperative period, during the first 4-5 days, you will need to adhere to a slag-free diet so that there is no stool. If peristalsis increases, Levomycetin or Norsulfazol is prescribed.

In order for the recovery to proceed normally, a dressing is done on the third day. Due to the excessive pain of the procedure, painkillers are used. The swabs in the wound are removed after preliminary wetting with hydrogen peroxide. Subsequently, an antiseptic treatment of the area is carried out and filling with tampons with Vishnevsky ointment or Levomekol.

On the 3-4th day after the excision of the fistula, suppositories containing novocaine and belladonna extract are placed in the anal canal.

If after 4-5 days there is no bowel movement, the patient is given an enema.

Rehabilitation involves adherence to a dietary diet.

• semolina porridge cooked in water;
• steam cutlets;
• broths;
• boiled fish.

The use of liquid is allowed in any quantity. Salting food and using spices is prohibited. After 4 days, the menu is supplemented:

• boiled vegetables (raw prohibited);
• dairy products;
• fruit puree;
• baked apples.

The patient who was operated on needs to do a sitz bath after each bowel movement, and then treat the wound with antiseptic solutions.

External sutures are usually removed after a week. The wound heals completely after 2-3 weeks. Doctors must warn the patient that for about three months, liquid stools and gases can sometimes come out arbitrarily. To maintain the tone of the sphincter muscles, it is recommended to perform special exercises.

If the fistula caused by paraproctitis was removed correctly, the prognosis will be as favorable as possible.

Also important is how accurately the operated person follows the recommendations of doctors.

• hemorrhages;
• violation of the integrity of the urethra;
• suppuration of the wound in the postoperative period;
• anus failure;
• recurrence of the pathology.

Pararectal fistulas pose a serious threat to health. Hoping for the independent disappearance of the pathological hole, a person runs the risk of getting complications up to the development of a cancerous tumor. Only through surgical intervention is it possible to completely get rid of an unpleasant phenomenon.

A fistula is a pathological channel that connects a hollow organ and the external environment or two hollow organs. Most often appears fistula after surgery. Treatment of this formation is quite long and painful. That is why the patient must strictly adhere to the doctor's instructions.

The fistula is a hollow neoplasm, which in its appearance resembles a deep wound. In accordance with the characteristics of the development of neoplasms, they can be:

• labial. In this case, there is an fusion of fistulas and skin, as well as muscle tissue. Removal of fistulas is carried out using a surgical method.
• Complete. It is characterized by the presence of two exits, which makes it possible to most effectively combat the inflammatory process.
• tubular. It is a fully formed channel, from which there is a constant discharge of feces, pus and mucus.
• Incomplete. The neoplasm is characterized by one exit, the location of which is the abdominal cavity. With this type of fistula, pathogenic microflora multiplies, and inflammation also aggravates.
• Granulating. With this type of fistula, granulation tissue is formed. With this pathological process, swelling and hyperemia are often observed.

About, what is a fistula after surgeryonly the doctor knows. After an appropriate diagnosis, a specialist will be able to determine the type of formation, which will positively affect the treatment process.

Reasons for the appearance

Postoperative fistulas may develop for a variety of reasons. Most often, pathology is observed against the background of an infectious process that enters the human body through sutures and wounds. After a surgical intervention, the human body may reject the thread, which is explained by intolerance to its components. Against this background, it appearspostoperative fistula. The development of neoplasms can be diagnosed in the presence of other provoking factors, which include:

• High immune reactivity of the organism;
• Elderly age;
• Chronic specific infection;
• hospital infection;
• Oncological diseases.

If vitamins and minerals enter the human body in insufficient quantities, this leads to the formation of fistulas. . Postoperative fistula, treatmentwhich is very long, appears in violation of the metabolism - diabetes, metabolic syndrome, obesity.

Before, how to treat a fistula after surgery, it is necessary to determine the cause of its occurrence. Therapy of pathology should be directed to its elimination.

Symptoms

Fistulas after surgery characterized by the presence of certain features. Initially, the appearance of a seal on the skin around the size is observed. There is pain on palpation. In some patients, the appearance of pronounced tubercles is diagnosed, which is used to secrete the infiltrate. Reddening of the skin may be observed at the site of infection of the scar.

The pathological process is often accompanied by a sharp increase in body temperature. This is due to the course of the inflammatory process in the human body. It is impossible to bring down the temperature to a normal value. Fistulas are accompanied by a purulent process. With untimely treatment of pathology, the size of the abscess increases significantly. In patients, there is a tightening of the fistulous opening for a certain period. This is followed by the development of inflammation.

Fistulas are characterized by the presence of certain signs. When they appear, patients are advised to immediately consult a doctor. Timely treatment of the disease will eliminate the possibility of side effects.

Features of therapy

Fistula treatment after surgery in most cases requires surgical intervention. Initially, the surgical field is treated with special antiseptic solutions, which will eliminate the possibility of infection. Surgery requires the use of local therapy. In order for the surgeon to find the course of the fistula as quickly as possible, a dye solution is introduced into it.

The surgeon removes the fistula with a scalpel. All other actions of specialists are aimed at stopping bleeding. After that, it is recommended to wash the wound with a solution with an antiseptic effect. Postoperative sutures are applied to the wound. In this case, it is recommended to use active drainage.

The treatment of postoperative fistulas requires the use of not only surgical intervention, but also appropriate medications. In most cases, patients are prescribed antibiotics and anti-inflammatory drugs:

• Diclofenac;
• Nimesila;
• Dicloberla.

In order to speed up the healing process of wounds, the use of Troxevasin or Methyluracil ointment is recommended. It is also recommended to use preparations that are of plant origin - aloe, sea buckthorn oil, etc.

That, how long does it take for a fistula to heal after surgerydirectly depends on the characteristics of the rehabilitation period. Patients are recommended daily hygiene procedures in the area of ​​the operation. The patient is advised to disinfect the sutures daily with the help of special preparations. The patient's diet should be rich in fiber, which will eliminate the possibility of constipation. In the postoperative period, it is recommended to exclude heavy physical exertion. Prolonged work in a sitting position should be abandoned for three months.

How does it appear fistula after surgery, what is itonly the doctor knows. That is why, if neoplasms occur, it is necessary to seek help from a doctor who will determine the type of formation and prescribe rational therapy.

Conclusion of morphology: Fistula ordinary is formed due to a crack without granulomas.

Drink Lavacol or Fortrans or enema preparation.

Blood analyzes (there are several of them, all by appointment)

A conversation with an anesthesiologist and asking him to either put you to sleep or be conscious is up to you.

Entering anesthesia through a catheter in the arm (it’s not pleasant when he is standing there after the operation before the morning) And introducing anesthesia into the spine, by the way, it doesn’t hurt at all.

The operation lasts from 20 minutes to 1 hour (who has what difficulties)

After the operation, who sleeps and who does not, this is for endurance.

Legs are not felt for about an hour.

After that, by the evening I was already running to the toilet, by the way, the most important thing is to go a little after the operation, you need to drink two liters of water. Many people have a problem, they cannot go, and then a catheter is inserted.

At night they inject some kind of drugs))) you sleep like a baby.

Day two, eat fully in the morning and then always, while drinking mukofalk is desirable.

You go for a dressing, they will turn everything around with your fingers and run for an injection of ketaral + baralgin. To not hurt.

So another week passes and after you are discharged home.

At home, make baths, candles and ointment.

Preliminary healing time is a month.

After surgery to remove the fistula. Why does it go into

#1 Irina76

And this means that the inner hole remained and the connection with the rectum also remained !!! If the air comes out, then the feces will come out and the operation failed.

On inspection only in a week, and until then I'll go crazy.

#2 Maksimov

#3 path

Don't go..! I will hold your hand

#4 Irina76

Unfortunately, the examination revealed that the operation was not a success.

They operated again, now with an incision and with suturing of the locking muscles.

After the operation, they only asked how much it hurts and if I could hold

But the wound where the fistula was remained. And pus flows from there, gases come out (I fart) and a little, as it were, defecation. This is fine.

It's just that this is the fourth operation in 8 months with this fistula. The first was

opening of acute paraproctitis. Drainage was inserted into the second one. The third failed.

I hope it helped now. I started having problems at work. They already hinted that they might be fired due to frequent sick leave.

PROCTOLOG81.RU / Coloproctology (proctology). Treatment. / Fistula of the rectum

"KDS CLINIC" - Coloproctology

Do you have any questions? Call! from 10:00 to 20:00

before the operation, I was closely involved in ballet and aerostretching. the other day she stood in a plié for a while, did not difficult exercises. It seems to me that they could not affect the fact that this wound broke through again. Or could they? I didn’t squat with dumbbells. at the last appointment, if it doesn’t overgrow, I can sew it up. Doctor, how do you think this is advisable? And why does it bleed once every two weeks and does not overgrow? There are no other symptoms. There is no discharge from the anus. Could this be from light exercise?

AFTER FISTULA OPERATION

Tell me, please, is this fibrin really similar to purulent discharge? And can a fistula relapse 2 weeks after a radical operation performed in a specialized proctology hospital? 🙁

Appointment for consultation: -50-03;

A week ago, an operation was performed to remove the posterior intrasphincteric fistula of the rectum:

When I returned home, after 2 days, brown blood came out of the wound without stopping. The stool was slightly firmer than when lying in the center.

Tell me, is this acceptable in my case? It happens? The wound is about 3-3.5 cm in diameter, and, accordingly, it is still deep.

Advise what to do and what to think. How often do dressings? I will be able to go to the inspection only in a week.

And, maybe this will seem like a stupid question to you, but could it not happen like this: what if it was torn, burst or parted, whatever, the fistulous opening that I had inside, which was excised along with the move, sort of.

You will help me a lot and calm me down a little, at least a little before the first examination.

Fistula of the rectum

2 months have passed since the excision of the transfinter fistula. Worries, firstly, the increased sensitivity of the site of excision of the fistula. How long will this sensitivity last? Secondly, a feeling of wetting (dampness) around the anus. There is no fecal incontinence, if desired, I hold back the gases. But there is a feeling that mucus is secreted, quite a bit, but discomfort is present. The operating surgeon says that over time everything will become normal, while little time has passed. Is it so? Is it time to start doing Kegel exercises?

apply for a consultation at KGKB no. 18 (b-r Shevchenko 17), department of proctology.

Reading the Internet doubted the appointment.

Please tell me if my concern is justified. Can all the same to go to the proctologist or all the same it is possible or probable to cure?

Thanks in advance for your reply.

Diagnosis: acute purulent retrorectal paraproctitis.

27.08.2014 an emergency operation was performed: "Opening and drainage of paraproctitis" under intravenous anesthesia. The postoperative period was uneventful, without complications. He was discharged on September 4. At home for up to a month there were ointment bandages with Levomekol, manganese baths. There was no hypothermia, physical exertion. But a month later, a hole appeared at the site of the operation, it healed in a week. Then it appeared again. There are no pain sensations, no high temperatures. As soon as the hole heals and disappears, another one appears. I visited a surgeon, a proctologist, they said that the fistula was deep, it was necessary to operate. So far, Proctosan candles and baths with potassium permanganate have been recommended. Please tell me if the operation is mandatory, maybe over time the hole will close with the help of an ointment or on its own, because there is no pain and purulent discharge.

Fistula of the rectum - treatment or excision surgery?

A fistula of the rectum or, in other words, a fistula is a pathological channel that occurs in the subcutaneous tissue of the rectum and passes through the tissues surrounding it. Fistulas are external and internal. The external fistula starts from the internal cavity and goes out into the lumen of the anal canal or to the surface of the perineum, the internal fistula connects the hollow organs inside the body.

For what reason are fistulas formed?

In almost 90% of patients, the appearance of a fistula provokes the final stage of acute paraproctitis. Often a patient with symptoms of acute paraproctitis delays going to the doctor. As a result, the abscess, which is formed in the subcutaneous tissue, spontaneously opens, and its purulent contents come out.

The patient feels significant relief, his health improves, he believes that he is completely cured. But this is far from true. An inflamed anal crypt remains in the wall of the rectum, through which the infection enters the surrounding tissues and the inflammatory process continues. At the same time, the tissues begin to melt, and a fistula is formed that comes to the surface.

Fistulas form as long as the inflammatory process continues. Therefore, fistulas are often called chronic paraproctitis. In some cases, the cause of fistulas is the error of the surgeon during the operation. This happens if the abscess is opened and drained, but no radical operation is performed. Or during an operation to remove hemorrhoids, the surgeon, while suturing the mucosa, captures the muscle fibers, as a result of which inflammation develops, followed by infection.

Fistulas can form as a postoperative complication in the surgical treatment of advanced and complicated hemorrhoids. Sometimes fistulas can be a consequence of birth trauma or occur after gross gynecological manipulations. In addition, the cause of their occurrence may be:

• chlamydia
• Crohn's disease
• malignant tumors in the rectum
• syphilis
• intestinal tuberculosis
• diverticular bowel disease

Types of fistulas

Full. In fistulas of this type, the entrance is located in the wall of the rectum, and the outlet is on the surface of the skin in the perineum or anal region. Sometimes in the region of the rectum, several inlets can form at once, which then merge into one channel in the subcutaneous tissue and form one outlet on the skin. The main distinguishing feature of complete fistulas is that they go out to the surface of the body.

During a diagnostic examination, a doctor using a special probe can easily penetrate into the rectilinear fistulous passages. If the channels are tortuous, it is almost impossible to do this and the specialist cannot gain access to the internal hole. In this case, doctors assume that it is located in the place where the initial introduction of the infection occurred.

Incomplete. This form of fistulas of the rectum does not have an outlet to the surface of the body, that is, these are internal fistulas. This type of fistulous tract is rarely diagnosed and is considered by many physicians as a temporary option for the development of a complete fistula. Incomplete fistulas may appear with the development of rectal, ischio-intestinal or submucosal paraproctitis. With such forms of paraproctitis, the abscess is often eliminated spontaneously, or opened surgically.

Patients may not even be aware that such a fistula is located inside their body, it is usually short and directed to a purulent area. Sometimes the fistula opens as two internal openings. An experienced specialist may suspect its presence according to the characteristic complaints of patients. Patients complain of periodic pain in the lower abdomen, the appearance of pus in the feces and an unpleasant odor.

According to the way the internal opening is located on the wall of the rectum, the fistulas are divided into lateral, posterior and anterior. By localization, fistulas are classified depending on how the fistulous canal is located in relation to the anal sphincter.

Transsphincteric fistula of the rectum is the most common, it is diagnosed in about half of the cases. Note that the fistulous canal is located in any one area of ​​the sphincter (on the surface, deep inside or under the skin). At the same time, the fistulous canals can branch out, the presence of abscesses is noted in the fiber, and cicatricial processes occur in the surrounding tissues. Such a fistula is usually located much higher than the anal sphincter, this is its feature and explains the branched form.

Intrasphincteric fistula of the rectum is considered the simplest of these pathological formations and is diagnosed in about 30% of cases. In another way, such fistulas can be called subcutaneous mucosal or marginal fistulas. The main distinguishing characteristics of this type are the recent duration of the inflammatory process, the direct fistulous canal and the unexpressed nature of cicatricial manifestations. The external fistulous opening is usually located in close proximity to the anus, and the internal passage can be located in any of the intestinal crypts.

Diagnosis of such fistulas is not particularly difficult; this can be done by palpation of the perianal region. The probe in these cases freely enters the external fistulous opening and easily passes to the internal opening of the intestine.

Patients with this diagnosis often require additional examinations. It can be a variety of methods of instrumental and clinical research. They will help to distinguish the chronic form of paraproctitis from other diseases that cause the formation of fistulas. In addition to the above types of fistulas, there is a classification that divides rectal fistulas into 4 degrees of complexity:

• 1st. The main feature is a direct fistulous course, there are no cicatricial changes in the area of ​​​​the internal opening, there are no infiltrates and pus in the pararectal tissue.
• 2nd. There are no purulent pockets and infiltrates, but scars appear around the internal opening.
• 3rd. It differs by a narrow opening of the inlet fistulous canal, while there are no purulent contents and infiltrates in the fiber.
• 4th. Abscesses and infiltrates appear in the pararectal tissue, multiple scars are located around the wide inlet.

In this case, the localization of the fistulous canal does not really matter, the symptoms are the same for any location.

Symptoms of a fistula of the rectum

The patient suspects an unpleasant complication when fistulous openings appear in the perianal region. From these wounds, pus and ichor are periodically released, which stain the linen and force the patient to constantly use pads and often perform perineal hygiene. If the discharge becomes profuse, it causes redness and irritation of the skin, itching, accompanied by an unpleasant odor.

Rectilinear fistulas that drain easily rarely cause severe pain symptoms. But incomplete internal fistulas can be very painful due to the chronic inflammatory process. In this case, the pain may increase when walking, coughing, during bowel movements. When the fistula canal is blocked with a purulent mass or granulation tissue, an exacerbation may occur, an abscess is formed, the temperature rises, and signs of intoxication of the body appear.

After opening the abscess, relief usually occurs, the acute manifestations subside, but since the fistula does not heal, the disease returns with relapses. During remission, the patient feels normal and, with careful hygiene, can lead a normal life. If the course of the disease is long and the fistulas of the rectum constantly remind of themselves with exacerbations, accompanying symptoms occur:

• Weakness, insomnia
• Decreased performance
• Intermittent rise in temperature
• nervous exhaustion
• Sexual disorders

If complex fistulas exist for a long time, severe local changes are possible: deformation of the anal canal, sphincter insufficiency, cicatricial changes in the sphincter muscles.

Diagnosis of the disease

At the initial stage, a patient is interviewed, during which complaints characteristic of this pathology are identified. Diagnosis of a fistula usually does not cause difficulties, since already during the examination, the doctor discovers one or more openings in the anal area, when pressed on which the purulent contents are separated. With a digital examination, a specialist can detect the internal opening of the fistula.

In addition to examination and history taking, the patient is prescribed tests: a biochemical blood test, a general blood and urine test, and a fecal occult blood test. This is done in order to confirm the diagnosis and exclude the presence of other diseases. In addition, a microbiological analysis of the purulent discharge is carried out to determine the microbe that causes suppuration. A cytological analysis of the discharge will determine whether these symptoms are a sign of cancer.

The decisive factor in the diagnosis of this disease are instrumental research methods:

1. Sounding. With the help of a special probe, which is inserted into the external opening of the fistula, the doctor determines the length and degree of tortuosity of the pathological canal.
2. Irrigoscopy. This method allows you to examine the colon with an x-ray, for which a contrast agent is first injected into it.
3. Ultrasonography. An informative and affordable diagnostic method for detecting rectal fistulas. The procedure is painless and harmless, allowing you to get an image of the organs from the inside using ultrasound. This is the same ultrasound, only the examination is carried out using a vaginal probe, and not a conventional probe.
4. Colonoscopy. The method allows you to examine the large intestine and even take a piece of the mucosa for examination (biopsy). For the procedure, an endoscope is used, which is inserted into the rectum. During the examination, the location of the pathological fistulous canals, their length and other mucosal defects are revealed.
5. Fistulography. X-ray examination of fistulas after filling them with a contrast agent. After the procedure, the radiopaque substance is removed from the fistulous canal by suctioning it with a syringe.
6. Sigmoidoscopy. This procedure makes it possible to examine the inside of the rectum and sigmoid colon to detect pathological changes. The examination is carried out using an endoscope.
7. CT (computed tomography). It is performed in case of suspected complications caused by rectal fistulas. During the examination, the condition of all abdominal organs is assessed for the timely detection of pathological changes.
8. Sphincterometry. Allows you to objectively assess the functioning of the rectal sphincter

All instrumental methods of examination are carried out in the clinic and are performed by experienced and qualified specialists. Before they are carried out, the patient is consulted and given recommendations on how to properly prepare for the examination.

These diagnostic methods will help to exclude other diseases in which the formation of holes in the anorectal region is also possible. These can be diseases such as tuberculosis, Crohn's disease, fiber cysts, osteomyelitis of the pelvic bones.

Treatment of rectal fistulas

Sometimes, before performing a surgical intervention, a specialist may prescribe antibiotic therapy, treatment with painkillers and local healing agents to the patient. This is done to alleviate the condition, in most cases, conservative therapy is ineffective. Physiotherapy procedures can be prescribed during preparation for surgery.

This is done to reduce the risk of postoperative complications. Do not try to treat fistulas with folk methods. Perhaps these funds will help to achieve temporary relief, but the main problem will not be solved, and time will be lost.

The main method of treatment of fistulas of the direct canal is surgical. Removal of the fistula of the rectum is the only radical way to treat pathology. Specialists explain that surgical interventions during remission are impractical, since during this period the fistulous passages are closed and there are no visible and clear landmarks. As a result, the surgeon may not completely remove the rectal fistula and damage nearby healthy tissue.

The choice of surgical intervention technique will depend on the type of fistulas, their localization, the degree of cicatricial changes, the presence of abscesses or infiltrates in the pararectal tissues. The surgeon must correctly perform the excision of the fistula of the rectum, if necessary, open and drain purulent pockets, suture the sphincter, close the internal opening of the fistula with a muco-muscular flap.

All necessary actions during the operation will be determined by the individual characteristics of the course of the pathological process. Excision of the fistula of the rectum is performed in a hospital using general anesthesia. After the operation, the patient must stay in the hospital for at least a week under the supervision of a doctor.

Features of the postoperative period: diet

Usually, within a few hours after the operation, the patient is allowed to drink liquids. As you recover from anesthesia, you may experience discomfort and quite intense pain. Therefore, during the first three days, the patient is prescribed painkillers.

A bandage is applied to the site of the surgical wound, a gas outlet tube and a hemostatic sponge are inserted into the anus. They are removed a day after the operation during the first dressing. Dressings are quite painful, to facilitate the procedure, the patient is prescribed treatment with local anesthetics (ointments, gels). During this period, the doctor must carefully monitor the healing process, it is important that the edges of the wound do not stick together and do not form non-draining pockets in it.

If complex fistulas were removed, then a week after the operation, bandaging under anesthesia will be required. During it, a deep revision of the wound is made and the ligature is tightened. To quickly heal the wound and reduce discomfort, the doctor may prescribe sitz baths with a decoction of chamomile or a weak solution of potassium permanganate.

In the first two days after the operation, the patient is prescribed a special liquid diet (kefir, water, a little boiled rice). This is done so that the patient does not have a bowel movement for several days after surgery. In the absence of stool, the postoperative wound will not become infected with feces, and the healing process will go faster.

In the postoperative period, it is important for the patient to follow a correct and balanced diet, nutrition should be fractional, you need to eat in small portions 5-6 times a day. Fatty, fried, spicy, pickled dishes, smoked meats, spices, sparkling water are excluded from the diet. You should give preference to foods high in fiber (vegetables, fruits), include cereals, grain bread, dairy products in the menu and drink more fluids.

This will help to achieve soft stools and improve bowel function. Avoid constipation and, if necessary, take laxatives.

After discharge from the hospital, the patient should be especially attentive to his own well-being and immediately consult a doctor if the following symptoms occur:

• Rapid rise in temperature
• Constant pain in the abdomen
• Fecal incontinence, excessive gas
• Painful bowel movements or urination
• The appearance of purulent or bloody discharge from the anus

These manifestations indicate the development of complications, it is necessary not to delay the appeal to a specialist and not self-medicate. In the absence of complications, the patient can return to normal life in two to three weeks. Full recovery and healing of wounds occurs six weeks after the operation. When you are discharged from the hospital, be sure to discuss with your doctor when to come for an appointment for a follow-up examination.

Possible Complications

What complications can occur after removal of the fistula of the rectum? In some cases, bleeding may occur. In cases where the rectal fistula existed for a long time and periodically worsened, intoxication and general poor health of the patient are noted. The constant inflammatory process contributed to the formation of scars in the tissues surrounding the fistulous canal.

Cicatricial changes occurred in the wall of the rectum, anal canal and around the sphincter. This can lead to the development of such complications as insufficiency of the anal sphincter and incontinence of feces and gases. In some cases, there may be a relapse (return of the disease). The most serious and severe consequence of rectal fistulas may be their malignant degeneration.

Prevention

In the prevention of the occurrence of rectal fistulas, the timely elimination of the cause that causes them, that is, the treatment of paraproctitis, plays an important role. In addition, it is necessary to exclude those factors that lead to traumatic damage to the rectum, treat a disease such as hemorrhoids in time and prevent its transition to a neglected form. Patients suffering from hemorrhoids, rectal polyps, benign tumors should be aware of the need for surgical intervention.

Timely treatment will prevent the development of paraproctitis, reduce the risk of fistulas and will be a good prevention of various complications. If you experience adverse symptoms in the rectal area, seek medical help in a timely manner, this will help you cope with the disease and avoid serious complications.

Surgical treatment of rectal fistula

One of the most common reasons that brings a patient to the office of a proctologist is a fistula of the rectum. This very unpleasant condition can develop in people of different sex and age due to certain circumstances. Most often, able-bodied men suffer from this problem, less often there are cases of fistula in young women after childbirth, even less often in children, including infants. This situation refers to the surgical direction of proctology and is eliminated only by surgery.

What is the problem

A fistula of the rectum is a chronic inflammation of the pararectal tissue (chronic paraproctitis) with the formation of a pathological canal that opens into the intestinal lumen, another hollow organ (for example, the vagina) or the perineum.

Most often, the formation of a fistula of the rectum is the next stage of acute paraproctitis and may be associated either with an incorrectly performed operation, or with a late visit to the doctor by the patient.

It has been established that for the onset of the disease, the penetration of infection from the intestinal lumen or inflammatory foci from other organs into the anal crypts (special folds in the wall of the rectum) is necessary. They are located approximately at a depth of 3 cm from the anus, through these formations mucus is excreted from the glands located in the submucosal layer of the intestinal wall. Pathogenic microbes first enter the anal crypts (cryptitis develops), then into the space surrounding the rectum (paraproctitis occurs).

The main reasons for the formation of a fistula:

• spontaneous opening of an acute abscess and the release of the contents to the outside - after that the patient feels relieved, believes that he has been cured, but inflammation in the anal crypt remains, gradually leading to purulent fusion of the surrounding tissues and the formation of a fistulous tract;
• complication after surgery to remove advanced hemorrhoids;
• incorrectly performed operation for acute paraproctitis - the abscess was opened and drained, but without radical excision of the surrounding damaged tissues;
• difficult childbirth (ruptures of the perineum, gross obstetric interventions);
• malignant tumor;
• rectal injury;
• Crohn's disease;
• specific diseases - syphilis, intestinal tuberculosis, chlamydia;
• diverticulosis.

Classification

For the convenience of proctologists in terms of choosing a method of surgical treatment, there are several classifications of rectal fistulas. By the number of holes it happens:

1. Complete fistula - has two entrances, one of which is located in the anal crypt (internal) and opens into the intestinal lumen, the other goes outside near the anus. It may have several inlets in the wall of the rectum, which merge in the pararectal tissue into one channel, which always opens on the skin next to the anus.
2. Incomplete fistula - has one internal opening, which is located on the mucous membrane of the rectum, does not come to the surface of the body, blindly ends in the perirectal tissue. Many proctologists consider such a fistula to be a completely unformed fistulous course.
3. Internal fistula - two holes are located on the wall of the intestine.

In relation to the fistulous course, 3 forms of fistulas are distinguished:

• transsphincteric - the most common, located in the ampullar part of the rectum, above the anal sphincter, are often branched;
• extrasphincter - located below the level of the upper rectal sphincter;
• intrasphincteric (subcutaneous-mucosal) - the simplest form with a direct channel, characteristic of fresh fistulas.

The most difficult is the second group, according to severity, 4 degrees of such fistulous passages are distinguished:

• the channel of the direct direction, scars around the internal opening are not observed, there are no abscesses in the fiber;
• scars appear around the internal entrance of the fistula, there are no abscesses in the fiber yet;
• narrowed entrance to the canal, infiltrates are determined in the fiber;
• the entrance is wide, there are numerous scars, abscesses in the fiber.

Clinical manifestations

All types of fistulas, despite their diversity, have similar symptoms, which are most pronounced in the period of exacerbation of the disease. Typical manifestations are:

• discomfort and pain in the anus, aggravated by tension, prolonged sitting, coughing;
• itchy dermatosis around the anus due to constant discharge of a purulent or bloody nature, an unpleasant odor from the fistulous opening;
• common symptoms are weakness, subfebrile temperature, headache and muscle pain.

The external opening looks like a small wound; when squeezed out, a sanious or purulent discharge appears. If the fistula is wide, then gases and feces come out through it. The disease can last for many years until the patient seeks help from a proctologist and cures it.

If the operation is not performed for a long time, then such a chronic fistula can transform into cancer or lead to the spread of infection and the development of peritonitis.

Diagnosis and treatment

The list of necessary diagnostic measures includes a number of studies necessary to clarify the diagnosis. They start with collecting an anamnesis, an external examination of the patient and a digital rectal examination, then the doctor prescribes a certain amount of tests and procedures individually for each patient:

• sigmoidoscopy;
• sounding of the rectum;
• test with dyes;
• fistulography with dyes;
• sphincterometry - determination of the degree of dysfunction of the sphincter.

Based on the results of the study, they determine the tactics of treatment. The fistula can be eliminated only with the help of surgical treatment. Conservative methods are more preferable for patients, some of them leave reviews on the forums about the use of sitz baths with salt, rinsing with antiseptic solutions, and the use of antibiotic ointments. All of these methods are temporary. Proctologists are unanimous in one thing - only surgery can cure a fistula.

When choosing a method of surgical treatment, they proceed from the classification of fistulas by type, form of location, the presence of scar tissue and the severity of inflammatory changes. The operation can be performed according to different methods, but the essence is the same - excision of the fistula and inflamed tissues around it. The procedure is performed under general anesthesia, in the period before and after the intervention, antibiotics may be prescribed depending on the patient's condition. Patient reviews are mostly positive, although there are doubts and fears about the return of the disease.

A successfully performed operation usually leaves no chance for recurrence, although no proctologist can give a hundred percent guarantee.

It is important to remember that a fistula does not form from scratch; before it appeared, the patient already had proctological problems. The operation cures the fistula, but cannot get rid of the recurrence of the problem while maintaining the same lifestyle, nutrition, and attitude towards one's health.

Removal of the fistula of the rectum and the rehabilitation period

Fistula of the rectum (chronic paraproctitis) is an inflammatory process in the anal canal with the formation of a pathological passage between the skin or subcutaneous tissue and the organ cavity.

What is a fistula

A fistula is a pathological formation that connects the intestine to the external environment. With paraproctitis, the following types are distinguished:

1. Full stroke, having an external opening on the skin and an internal opening in the intestinal lumen.
2. Incomplete fistulas, characterized by the presence of only an internal opening. In most cases, they are transformed into a full form after the melting of external tissues.
3. If both holes are within the intestine, then the formation is called an internal fistula.
4. If the course has branches or several holes, it is called complex. Rehabilitation after the operation of the fistula of the rectum in such cases is delayed.

In relation to the location to the anus, extra-, intra- and transsphincteric fistulous passages are distinguished. The former do not come into direct contact with the sphincter, the latter have an external opening near it. The crossphincteric always passes through the external sphincter of the rectum.

Symptoms

Through the fistulous opening, purulent or bloody contents are released into the environment, which can cause irritation of the skin. Also, patients may complain of itching in the perianal area.

Pathological secretions cause psychological discomfort, there is constant contamination of linen and clothing.

Patients are concerned about pain syndrome of varying severity. Its intensity directly depends on the completeness of the drainage of the fistula. If the exudate is evacuated in full, the pain is weak.

In the event of a delay in the anal zone secreted in the tissues, the patient will be disturbed by severe discomfort. Also, the intensity increases with sudden movements, walking, sitting for a long time, during the implementation of the act of defecation.

A feature of the course of chronic paraproctitis is the alternation of periods of remissions and exacerbations. A complication may be the formation of abscesses, which can open on their own. Fistulas of the rectum sometimes contribute to the replacement of normal scar tissue, which leads to deformation of the rectum and the adjacent area.

Patients experience insufficient functionality of the sphincter as a result of its narrowing. The danger of a long-term presence of a fistula lies in the possibility of the affected tissue becoming malignant.

The protracted course of the disease negatively affects the general condition of the patient. Gradually, patients become emotionally labile, irritable. Sleep problems may occur, memory and concentration deteriorate, which negatively affects the implementation of labor activity.

When to have surgery

The protracted course of the pathology is an undoubted indication for surgical intervention.

Usually this duration lasts for years, the periods of remission gradually become shorter, the general condition of the patient worsens.

The presence of the latter can significantly complicate the work of proctologists. Reviews of the treatment of rectal fistula without surgery are not encouraging, basically all patients come to the conclusion that intervention is necessary.

The course of surgical interventions

There are several types of operations in the treatment of rectal fistula.

The dissection of a pathological formation can be carried out by two methods - a ligature and a one-stage incision.

At the first fistula and surrounding tissues are tied with threads. The resulting ligature is untied and re-tied every 5 days, gradually cutting off pathological tissues from healthy ones. The entire course of the operation is usually carried out in a month. A significant drawback of the method is long healing and prolonged pain after, and the functionality of the anal sphincter may also decrease in the future.

The method of one-stage excision is simpler and more affordable. A surgical probe is passed through the external opening into the fistulous canal, the end of which must be brought out of the anus. After the probe is dissected pathological tissues. A lotion with a healing ointment is applied to the resulting wound surface. The area of ​​surgical intervention gradually heals and epithelializes.

One-stage dissection has disadvantages - long wound healing, the risk of recurrence, the ability to touch the anal sphincter during surgery.

Learn from this article how to treat purulent paraproctitis.

The next variety implies a one-stage excision with suturing of the formed wound surface. Differences are in the methods of suturing.

The first way is to sew the wound tightly. After dissection and removal of pathological formations, streptomycin is poured inside. Then the wound is sutured in several layers with silk threads.

The sutures are removed approximately 2 weeks after the operation. They are strong enough, the risk of discrepancy is minimal.

The second method implies a fringing incision around the fistula. The latter is completely removed to the mucous membrane, after which the surface is covered with antibacterial powder, the wound is sutured tightly. Suturing can be carried out both from the outside and from the side of the intestinal lumen.

Some surgeons prefer not to close the wound tightly, only its openings. Swabs with ointments are applied to the lumen to promote healing. This technique is rarely practiced, since the risk of discrepancy is quite high.

1. Another method is that after complete excision of the fistula, skin flaps are sutured to the surface of the wound, which contributes to its faster healing. The method is quite effective, since relapses are rare.
2. Sometimes, when a fistula is removed, the intestinal mucosa can be brought down, which means its suturing to the skin. The peculiarity of this surgical intervention is that the fistula is not removed, but is covered on top of the mucosa. Thus, the pathological canal gradually heals on its own, since it does not become infected with intestinal contents.
3. The most modern methods are laser cauterization of the fistula or its sealing with special obturator materials. The techniques are very convenient, minimally invasive, but applicable only to simple formations that do not have complications. Photos of the fistula of the rectum after surgery with a laser or filling indicate that this technique is the most cosmetic, helps to avoid cicatricial changes.

It is important to note that the main goal of any type of intervention is to preserve the functioning of the sphincter in full.

Postoperative period

The postoperative period of excision of the fistula of the rectum for the first couple of days requires bed rest. An important condition for successful rehabilitation is adherence to a diet. The first 5 days you can eat cereals on the water, steamed cutlets, low-fat broths, boiled fish.

The diet after the operation of the fistula of the rectum after this time period is expanded, boiled vegetables, fruit purees, yogurts can be added to the menu. Prohibited alcoholic and carbonated drinks, raw fruits and vegetables, peas, beans.

Within a week, antibacterial therapy with broad-spectrum drugs is carried out.

The patient should have a stool 5 days after the operation, if this does not happen, an enema is indicated.

Patients undergo dressings with anti-inflammatory and analgesic drugs. It is acceptable to use rectal suppositories to reduce pain.

It is important after the act of defecation to toilet the wound with antiseptic solutions.

The sutures are removed after 7 days, full recovery after fistula surgery occurs 3 weeks after the intervention.

How to avoid relapse

Despite all the measures taken, in 10-15% of cases, a relapse of the disease may occur. This usually occurs with complex moves, incomplete implementation of the volume of intervention, rapid fusion of the edges of the wound while the channel itself has not yet healed. Symptoms of recurrent fistula of the rectum after surgery are the same as before.

If after a while they begin to disturb the patient, this indicates the need to consult a doctor again.

To avoid this, it is necessary to constantly carry out hygiene procedures, it is better after each act of defecation (normally it occurs once a day), treat anal fissures and hemorrhoids in time, and sanitize sources of chronic inflammation in the body.

It is also important to avoid constipation. For this purpose, you need to drink a sufficient amount of liquid, do not eat gas-producing foods. The patient should avoid obesity and try to maintain the glucose level within the normal range.

After surgery, a fistula can occur for many reasons. It usually appears after operations on the abdominal and tubular organs. The fistula may not heal for a long time, leading to damage to many parts of the body and, in some cases, to the formation of malignant tumors. The formation of a non-healing wound indicates that an inflammatory process is taking place in the body.

Causes of fistulas after surgery

If during a surgical intervention a foreign body enters the body, causing inflammation and infection, postoperative complications may begin. There are many reasons for this. One of them is a violation of the removal of purulent masses from the fistula channel. The occurrence of an inflammatory process may be due to the difficulty in the exit of purulent masses due to the narrowness of the channel, the presence in the drainage fluid of the products of the work of the organ that has undergone surgical intervention. In addition, the reasons for the formation of non-healing postoperative wounds can be improper operation and infection in the open wound.

A foreign body that has entered the human body begins to be rejected. As a result, the immune system is weakened, the body ceases to resist infections. All this delays the recovery period after surgery and causes encapsulation - infection of the operated organ. In addition, a foreign body in the body causes suppuration, which serves as an additional factor interfering with the healing of the suture. Such cases include bullet wounds, closed fractures and other injuries to the body. Ligature fistulas occur when the body rejects the threads that fasten the edges of the wound.

The appearance of a fistula on the seam can occur both in the first days after the operation, and many years later. It depends on the severity of the inflammatory process and the depth of tissue incision. The fistula can be both external (coming to the surface and in contact with the external environment) and internal (the fistula channel goes into the cavity of the organ).

Postoperative fistula can be created artificially. It is introduced into the digestive system for artificial nutrition of the patient. An artificial fistula of the rectum is formed for the unhindered removal of feces.

Fistulas in the human body can form in various chronic or acute diseases that require urgent surgical intervention.

If a cyst or abscess occurs in the cavity of an organ, bone or muscle tissue (with the further appearance of a fistulous canal), doctors excise the suture again. If the inflammation is not eliminated, the infection becomes more severe and leads to the formation of new fistulas.

Types of postoperative fistulas

A ligature fistula is formed after the application of non-absorbable sutures and with further suppuration of the sutures. They exist until the surgical threads are completely removed and are able not to heal for a sufficiently long time. A fistula resulting from tissue infection is a consequence of non-compliance with the rules of antiseptic treatment of the suture or subsequent divergence of the sutures.

Fistulas of the rectum or genitourinary system lead to a deterioration in the general condition of the body. The excretion of feces and urine to the outside is accompanied by an unpleasant odor, which causes a lot of inconvenience to a person. Bronchial fistulas are a complication of surgery to remove part of the lung. So far, there are no more advanced ways of suturing the bronchi.

Methods of treatment of postoperative fistulas

In the presence of strong immunity and the absence of infection of the operated tissues, the recovery period ends successfully. However, in some cases, the seam may become inflamed. The resulting ligature fistula is treated with surgical methods. When diagnosing ligature fistulas, doctors use methods to determine the location of the foreign body that caused inflammation and the development of the fistula. Such methods include double shots, the method of four points and tangent planes. When the fistula is opened, the foreign body itself and purulent masses are removed through its canal.

With a successful outcome of the treatment, the inflammation is eliminated and the fistula resolves itself. Spontaneously, this process can occur in very rare cases. Usually it takes a lot of time, the disease can become chronic and cause serious complications. The number of fistulas formed depends on the number of infected ligatures and the vital activity of pathogens. Depending on this, the frequency of the periodicity of the exit of purulent masses from the fistulous canal changes. Ligature fistula is treated both medically and surgically.

Conservative treatment is recommended with a minimum number of fistulas and pus secreted from them. The essence of the treatment is the gradual removal of dead tissue that interferes with wound healing and the removal of surgical sutures. In addition, the patient is recommended to take drugs that strengthen the immune system. For faster and more effective treatment, it is necessary to take antibiotics and treat the affected area with antiseptics.

The seam is usually treated with hydrogen peroxide or furacilin solution. This helps to remove purulent discharge, protect the wound from infection and speed up its healing. During inpatient treatment, constant ultrasound monitoring is carried out, which is considered the most gentle method of treatment.

Surgical intervention is prescribed for patients with a large number of fistulas and a fairly intense outflow of purulent masses. Also, this method is used when there is a foreign body in the body and serious postoperative complications. To prevent the occurrence of ligature fistulas after surgery, it is recommended not to use silk threads for suturing and to observe antiseptic measures.

Surgical treatment of such complications involves excision of the fistulous canal, cauterization or removal of granular tissues along the entire canal with a curette. In addition, the surgeon removes the festering suture material.

If necessary, an operation is performed over the suture to remove it, along with surgical threads and fistulas.

When one of the ligatures becomes inflamed, only part of the suture is excised and removed. After that, the sutures are re-applied.

If the treatment of postoperative complications is not started in time, they can turn into a chronic form and lead the patient to disability. Treatment of a ligature fistula should begin when its first symptoms appear.

Treatment of a fistula with folk remedies

In the early stages of the disease, treatment with folk methods can be quite effective. Good results are obtained by treatment with a mixture of vodka and olive oil. The mixture must be used to treat the affected areas. After performing this procedure, a cabbage leaf is applied to help draw out the pus. The course of treatment lasts several weeks, after which the fistulous canal disappears.

Fistulas on the skin can be cured with a mixture of aloe juice and mummy. Mummy should be soaked in warm water, the resulting solution mixed with aloe juice. This medicine is used in the form of gauze compresses. A good result is also given by compresses with a decoction of St. John's wort. 2 tbsp. spoons of dry grass pour a glass of water and bring to a boil. After that, the broth is filtered and used for compresses. For treatment, you can also use fresh leaves of St. John's wort. They are placed on a film that is applied to the affected area. The course of treatment lasts until the wound is completely healed.

Fistula of the rectum can also be cured by folk methods. Mix a small amount of toadflax flowers, water pepper leaves and oak bark. The mixture must be cooked over low heat in an oven. The finished ointment with a cotton swab lubricates the affected areas. The course of treatment lasts about 3 weeks. The same method can be used in the treatment of vaginal fistulas. Such an ointment can also be prepared using onions.

Fistula of the rectum refers to diseases that do not pose a great danger to the body. However, the disease is unpleasant, knocking the patient out of the usual rhythm of life. In case of illness, a hole (fistula) opens into a hollow organ or directly outward, through which pus, mucus comes out. Surgery will be required to remove the fistula. The cause of the problem lies in the development of fiber diseases.

If it happened - after the operation, recovery plays an important role. It is necessary to go through all the prescribed procedures, examinations so that the disease does not start to progress again. About 80% of patients are men. Accelerate the development of fistula anal fissures, hemorrhoids. Another reason is prolonged diarrhea after surgery.

Fistula of the rectum (rectal fistula) has the following varieties:

• Full, with 2 holes. One is open to the intestines, the second - to the outer part, near the anus.
• Incomplete that open in one direction only. They can be internal or external. They develop mainly after the removal of tumors, intestinal tuberculosis, unprofessional biopsy. Damage to the walls of the gastrointestinal tract leads to the spread of intestinal bacteria into the pararectal cavity.

A person can diagnose the disease if he finds pus, or feels discomfort in the perianal zone. Wounds sometimes secrete pus, cloudy blood. You have to constantly change linen dirty in the blood, use moisture-absorbing products, and perform hygiene of the perineum. With strong discharge, irritation of the skin occurs. Constant itching, an unpleasant odor are the first symptoms of a fistula.

The rectilinear fistula is quickly eliminated. Severe pain does not appear. Incomplete fistulas cause regular discomfort due to the chronic course. With any sudden movement, the symptoms are aggravated. Blockage of the fistula channel threatens to increase the amount of pus. Exacerbations, abscesses, fever, intoxication due to accumulation of pus are possible.

Symptoms

The following symptoms occur:

• weakness, lack of sleep;
• decrease in concentration;
• an increase in body temperature during certain periods (often at night);
• nervousness.

Recovery after surgery should be carried out under the supervision of a professional. With a long absence of treatment, incorrect methods used after surgery, serious changes are possible. The anus is deformed, scars form on the sphincter muscles.

Treatment of rectal fistulas

Prior to the surgical operation, which is the main method of getting rid of the fistula of the rectum, additional treatment may be prescribed. Antibiotics, painkillers, healing substances are used. Medications are taken to improve the condition, but most often such therapy does not bring significant relief.

Physiotherapy may be prescribed in preparation for the operation. The need for physiological procedures is to reduce the risk of complications after the surgeon's actions.

It is not necessary to treat a fistula with folk methods. Substances used may provide temporary relief. It is unlikely that they will be able to do something with their help, but time will be lost.

Remove rectal fistula is the only solution to the problem. Specialists do not treat in remission. The fistulous passages are closed, the pus stops oozing, it is difficult to determine the site of the operation. The surgeon can partially remove the problem area, touch the healthy part of the digestive system.

The type of fistula determines the pathogen removal technique. The size of diseased areas, the rate of pus release affect the methods used. The surgeon needs to correctly cut off the fistula, drain the purulent canals, if necessary, sew up the sphincter, and close the damaged cavities.

The steps are different in each case. The use of general anesthesia is mandatory, the patient is under the supervision of a doctor for about 10 days.

Features of the postoperative period

It takes time for the complete healing of the damaged cavity, fistulous passages. Stages of the postoperative period are divided into inpatient and outpatient.

The first part of the recovery - the patient is placed in a hospital under observation. A tube is installed that removes gases, analgesic drugs, antibiotics are prescribed. Bandaging is carried out several times a day.

Eating is allowed 12 hours after the operation., necessarily finely ground. Frequent fluid intake is recommended. In 90% of cases, baths are prescribed, in which an antiseptic solution is added, ointments for pain relief. If necessary, laxatives, other required substances. In the hospital, the patient is delayed for the time required for partial restoration of functions, wound healing.

outpatient period

• The fistula heals for a long time, the discharge does not stop for 3 to 5 weeks. It is recommended that at the end of the outpatient period, leaving the hospital, do not stop taking sitz baths. Carry out procedures in the morning and evening with the addition of prescribed medicinal infusions, antiseptic preparations. The wound should be covered with sterile bandages, lubricated with disinfecting ointments. Baths are also taken after the next bowel movement.

A mandatory measure, if the rectum is prone to disease, is a diet. The patient consumes the required amount of liquid to soften the feces, fiber. Spicy foods, alcohol are excluded. It is not recommended to be in a sitting / standing position for a long time. It is forbidden to perform heavy physical work, lifting any heavy objects.

• Any violation of the regime provokes the opening of the wound, prolonged healing. Recommendations are described by the attending physician - proctologist.
• After some time (usually a day), the patient is allowed to drink water. After anesthesia, there are unusual sensations in the body, sometimes severe pain. The first few days the patient drinks a course of painkillers.
• After the first dressing, they are removed. Bandaging is a painful procedure for the patient. Mandatory preparations of local action on the body. The attending physician controls the healing: the edges of the wound should not stick together, no suppuration should accumulate, no drainable pockets.
• If the operation was complicated, after a few days there is a need for dressing under anesthesia. A deep processing of the site of the operation is done, the ligature is tightened. To heal the wound faster, baths with potassium permanganate or chamomile are performed.

Diet after removal of the fistula of the rectum

After the operation, it is necessary to use not only medicines that accelerate the healing of the resulting wound, but also other methods. Diet helps the body cope with damage. It is necessary to eat food rich in vitamins, nutrients, so that recovery goes faster. Food is divided into small portions, consumed evenly. Products should not adversely affect the stomach, promote flatulence, constipation.

It is advisable to avoid bowel movements for the first 20 hours after the operation. The patient must fast for several hours. After the second day you can eat. Products are steamed or baked. Vegetables are used in any form. The following foods are allowed:

• Bread made with wholemeal flour or wheat.
• Baking, drying (not rich).
• Soups on the broth of meat, vegetables. Necessarily light, without the addition of numerous seasonings. You can eat cold dishes: beetroot, fruit or vegetable soups.

• Lean meats. The product must be boiled or baked.
• Fish, only sea. Definitely boiled or stewed.

• Premium sausage, milk sausages.
• Vegetable dishes, snacks. Greens are used processed or raw, fermented.
• Porridges, which are a source of useful components. Most often, try to eat buckwheat, rich in carbohydrates that energize the body.
• Useful baked, boiled pasta.
• Green peas and bean curd.

• Eggs are consumed boiled, preferably as part of other dishes.
• Low fat dairy products.

There is a list of products prohibited for consumption in the postoperative period. These include any dishes or components that increase blood flow to the pelvis. The prohibited category includes:

• alcoholic beverages, preservatives, smoked meats;
• complex proteins and dishes based on them (goose, lamb, pork meat);
• mushrooms, which are difficult to digest food;
• products that enhance the process of gas formation in the esophagus can be consumed, but in limited quantities;
• pastries, pastries, cakes;
• high-fiber fruits, garlic, onions, spinach;
• legumes, peas, beans, whole milk;
• fried meals.

If you follow the rules of dietary nutrition, recovery will be significantly accelerated. Proper nutrition helps to remove the complications that arise when unwanted substances enter the body that slow down the healing process.

Prevention

As a preventive measure, so that the disease does not recur, the timely treatment of paraproctitis plays an important role. It is important to completely get rid of the factors leading to injuries of the rectum. Preventive methods of dealing with the fistula of the rectum:

• Timely treatment of diseases of the rectum. It is necessary to heal anal fissures, to prevent the progression of hemorrhoids.
• Timely disposal of diseases, a symptom of which is itching. Prevention of irritation of the skin around the anus. It is important to diagnose and eliminate colitis, diabetes, invasion and other similar diseases so that the development of extraneous problems does not happen.
• Proper nutrition. Digestive organs directly affect the occurrence of fistula. Constipation, diarrhea are the first digestive disorders leading to the development of pathology.
• Being in a suitable temperature zone. Hypothermia of the organs increases the likelihood of the onset of the disease.
• Hardening of the body and personal hygiene.

Subject to the above recommendations, the likelihood of a fistula of the rectum is significantly reduced, its excision is not required. If symptoms of the disease are detected, you should consult a doctor to diagnose disorders at an early stage.

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 100% guarantee of a successful outcome. So, about 10% 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 immediately, upon detecting profile symptoms, sign up for a consultation with.

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:

1. Full. Includes two holes that are localized in the intestinal wall and on the skin.
2. Incomplete. It has only one outlet: internal or external.
3. Simple. Provides only one move.
4. 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 period will be announced, 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;
• ultrasound procedure;
• 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, a conclusion,. 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 and causing increased gas formation. These include:

• raw vegetables and fruits;
• black bread;
• legumes;
• sweets;
• in its purest form;
• 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 clotting;
• 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;
• sciatic-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, cooked on;
• 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 and;
• dairy products;
• fruit puree and baked .

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.