Fistula at the seam after caesarean section. Postoperative fistula on the abdomen treatment

Most serious operations end with the application of a ligature - a special thread that sews together damaged tissues in layers. Usually during the operation, the wound is thoroughly washed before sewing up. This is done using resorcinol, chlorhexidine, iodopyrone and other solutions. If the thread becomes contaminated with bacteria, or the wound has not been sufficiently treated, then suppuration of the ligature occurs and, as a result, a ligature fistula is formed.

Around the thread that tightens the edges of the wound, a seal is formed, called a granuloma.. The suture itself, collagen fibers, macrophages and fibroblasts get into this seal. The ligature itself is not encapsulated - it is not limited to the fibrous sheath. After such suppuration is opened, a fistula is formed. Most often, one fistula is formed, but there may be several, depending on where the ligature remains.

Usually, such a complication makes itself felt quite quickly, even during the patient's stay in a medical institution, therefore, during a routine examination by a doctor, the symptoms of a ligature fistula are detected and treatment occurs in a timely manner. A fistula is opened after a few days - a breakthrough appears on the skin, through which a purulent discharge oozes. Together with this detachable part of the ligature may also come out. In some cases, the process fades, the fistula closes, but after a short time it opens again. The purulent process can last for several months if you do not consult a doctor in time and remove the cause of suppuration.

Most often, ligature fistulas appear when the postoperative wound is sutured with silk threads. It is worth noting that at the present stage they are trying to use the suture material that is resorbable, so as not to remove the sutures later, for example, catgut.

Symptoms of a ligature fistula

Usually, a fistula cannot be overlooked - its external signs are clearly expressed.

• First, around the wound channel there is a seal and infiltration. The bumps that appear are hot to the touch.
• Secondly, near the scar left after the operation, you can clearly see the inflammation - redness will go in the course of applying the ligature.
• Thirdly, the wound begins to fester quickly and purulent contents are separated from the outlet. The volumes of the discharge may be insignificant, but with a rapidly developing process, a noticeable weeping may be observed.
• Fourthly, such processes provoke swelling of nearby tissues and an increase in body temperature to significant levels (39 degrees and above).

Treatment of ligature fistula

Treatment of a ligature fistula should be started as soon as possible, since this is a serious complication that can lead to secondary infection, disability, and in severe, advanced cases, to sepsis, which threatens the patient with death. Only a doctor should prescribe treatment, and if suppuration occurs at home, the patient must be urgently sent to the hospital. Treatment of a ligature fistula can be implemented in two ways - surgical and conservative. Surgical treatment is most often used - it consists in removing the infected ligature, after which the patient must undergo a course of antibiotic therapy. The patient is made a small incision to allow the pus to drain out. This will protect the patient from the development of phlegmon - purulent fusion of tissues, as a result of which it will be much more difficult to cure the disease. If the ligature can be removed, then the fistula is closed. Otherwise, a second attempt is made after a few days until the ligature is removed.

In severe cases, when ligatures are multiple and whole fistulous tracts are formed, excision of the entire postoperative scar along with the remnants of ligatures is indicated.

The wound surface requires special care - the affected area must be washed with special solutions to rid the wound of pus and avoid further development of the pathological process. Usually, hydrogen peroxide or furacillin is used for this purpose. If there are excessive granulations, they are recommended to be cauterized. After the primary care is provided, if necessary, the ligature is applied again.

Conservative treatment is possible only when the process is just beginning and the amount of discharge is minimal. In this case, the dead tissue around the fistula is removed from the patient, the pus is thoroughly washed out. If possible, also cut off those threads, the endings of which go out. Next, the patient is given antibiotics and drugs that increase immunity.

Prevention

To avoid the occurrence of a ligature fistula, it is necessary to properly treat the wound before suturing and use only sterile suture material. Also, when the first signs of this complication appear, it is necessary to provide timely assistance. Usually the outcome is favorable.

Every operation, and delivery by caesarean section is no exception, ends with a suture. The purpose of incision processing is to stop bleeding, to prevent massive blood loss. For this, a suture material such as a ligature is used, which normally does not cause any complications to patients.

If the reaction of the body to the ligature is unpredictable, a focus of inflammation is formed around the threads, an abscess is formed with purulent fusion of tissues. The generally accepted requirements for the antisepsis of the surgical material and the surgical field require careful processing of the incision before suturing. If pathogenic bacteria get into the wound, an inflammatory process will inevitably develop, complicated by the formation of a fistula.

Around the ligature, which tightens the edges of the incision, the tissues are compacted, forming a granuloma. It consists of collagen fibers, suture material, fibroblasts. The introduction of pathogenic bacteria into this tissue causes suppuration. Pus finds a way out, and a through hole, or fistula, is formed. The ligature fistula may be the only one, or pus erupts in several areas of the surgical suture.

The time of formation of such a complication ranges from 2-3 days to several months. When the intensity of inflammation decreases, the ligature fistula may spontaneously close for a while, but the final recovery does not occur until the source of suppuration is removed.

Reasons for the appearance

For the appearance of a fistula after a caesarean section, there must be predisposing factors.

Common causes of the formation of a ligature fistula:

Infected suture material;

Infection of the surgical field;

Low quality ligature;

Violation of the rules of antisepsis during and after the operation;

Incorrect processing of the surgical suture;

The loads associated with pregnancy and childbirth, a stress factor, weaken the woman's immunity. This circumstance significantly increases the risk of an inflammatory process, rejection of foreign material (ligature), the appearance of an allergic reaction to it.

The danger of education

With the formation of a fistula on the seam left after a cesarean section, immediate action is required, because the risk of secondary infection of the body increases. Intense purulent discharge leads to irritation and maceration of the skin, the appearance of dermatitis.

Further development of the inflammatory process leads to intoxication of the body with the products of tissue decay and the vital activity of pathogenic bacteria. With a rupture of the fistula, there is a high probability of infection entering the bloodstream, which leads to the development of sepsis. This complication can lead to disability and even death.

Complications of ligature fistula:

Toxic-resorptive fever - the reaction of the body to the formation of a purulent focus and the accompanying high temperature, negatively affects the functioning of most organs;

The appearance of phlegmon - the spread of inflammation in the subcutaneous fatty tissue;

Prolapse of abdominal organs from a molten wound.

Complications can be prevented only by timely diagnosis of the ligature fistula.

Symptoms

Women who have undergone a caesarean section should be aware of the main symptoms of the onset of pathology, because a ligature fistula can form several months after the operation.

Higher temperature of the skin around the seam compared to the rest of the body;

The separation of pus, ichor from the seam, sometimes it can be minimal, giving the impression that the wound is getting a little wet.

When a ligature fistula appears, the body temperature always rises. At an early stage of the onset of complications, temperature values ​​\u200b\u200bmay be close to normal, but still increase. The more the inflammatory process develops, the more pronounced hyperthermia.

Diagnostics

Not all women can independently detect the onset of the inflammatory process in time. Usually the patient goes to the doctor when the infection of the wound has gone too far. If the wound after caesarean section is regularly examined by a specialist, it is possible to detect the pathological process at the earliest stages, to prevent complications.

Palpation of granular tissues;

Studying the anamnesis, complaints of the patient;

Probing of the ligature fistula to determine the parameters of the defect;

Ultrasound with contrast;

X-ray examination with the introduction of a contrast agent.

Treatment

It is categorically unacceptable to self-medicate a ligature fistula after a cesarean section at home or wait for the surgical thread to come out on its own. Only in the conditions of a surgical hospital is it possible to prevent the spread of infection, open suppuration and remove the fistula.

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Surgical treatment

There are two tactics for the surgical treatment of a ligature fistula - the doctor removes the thread that caused the inflammation, or excised the entire fistula, which is preferable in many cases. The thread is removed blindly through a small incision in the seam area. Suppuration is freed from ichor and pus, washed with an antiseptic solution. If it was possible to completely get rid of the cause of inflammation, the fistula is finally tightened. If there are recurrences, the operation is repeated.

A wide incision is not made, because there is a risk of cellulitis and the spread of infection to healthy tissue. The surgeon may decide not to make an incision, but to remove the ligature from the fistulous canal with a special tool. After performing the manipulation, the wound is treated with antiseptic preparations, the bandage is regularly changed on it.

In modern clinics, the procedure is carried out under the control of ultrasound scanning, which allows you to accurately determine the localization of the ligature that caused inflammation.

A radical way to get rid of the focus of inflammation is a single-block excision of the fistula. In this case, both the fistulous canal and the suture material that caused the pathology are removed. The operation is performed under local anesthesia, with careful observance of the rules of antiseptics. After removal of the fistula, the wound is sutured, its condition is monitored for 5 days. After the site of excision of the fistula has healed, the sutures are removed from the wound.

Conservative treatments

In the case when the inflammatory process has not yet gone too far, it is possible to use drug therapy. It consists in treating the inflamed area with antibacterial and antiseptic solutions. The purpose of the treatment is the destruction of pathogenic bacteria in the entire area of ​​the wound. Treatments are often carried out to effectively remove pus and disinfect the suture site.

If in this way it is possible to stop the inflammation, the ligature fistula may be delayed spontaneously. To support immunity, immunostimulants and vitamin complexes are prescribed. A course of antibiotics will help keep the infection from spreading. When the body's defenses increase, the focus of inflammation will decrease or disappear altogether.

With this method of treatment, there is always a risk of recurrence, since the suture material remains in the wound. If the appearance of a ligature fistula was provoked by a surgical thread, the process may be repeated.

Prevention

Even with the strictest observance of the rules of antisepsis during cesarean section, there is a risk of a ligature fistula. It is impossible to predict in advance whether a woman will experience a rejection of the suture material or not. However, preventive measures can help prevent complications.

Rational management of caesarean section;

Compliance with the rules of antiseptics;

Careful preparation of the operating field;

Use of modern surgical materials.

To prevent the development of inflammation of the suture after cesarean section, you need to carefully monitor its condition for several months after the operation.

A fistula is a channel that connects a body cavity or hollow organs with the external environment or with each other. Another fistula is called a fistula. Most often, it is represented by a narrow tubule, which is covered from the inside with epithelium or young connective tissue. Fistulas can form against the background of various pathological processes occurring in the body, as well.

A fistula on the gum of a tooth is a pathological formation represented by a small passage through the gum to the lesion. Most often, the fistula comes from the root of the diseased tooth. On it, serous or purulent exudate is discharged from the focus of inflammation. You can see the fistula in the place of the projection of the tooth, in its upper part. It looks like a hot spot.

Pararectal fistula occurs as a result of a violation of metabolic processes in the fiber around the ampoule of the rectum. Most often, these are the consequences of paraproctitis, or proctitis, a symptom of which is an abscess of fiber. Its main manifestations are purulent or spotting, pain, itching, irritation of the epidermis of the anal area.

The information on the site is intended for familiarization and does not call for self-treatment, a doctor's consultation is required!

Ligature fistula after surgery: what you need to know about it?

Complications arising after surgery, ligature fistulas, are dangerous for the patient, as they become a source of infection and can cause severe intoxication of the body.

Causes of ligature fistula after surgery

Any surgical intervention is completed with postoperative treatment, which consists in suturing, performed with a ligature, a special surgical thread, absorbable or non-absorbable.

The use of non-absorbable, usually silk, threads suggests that they will remain permanently at the site of the wound, undergo an encapsulation process and will not cause any harm to the patient.

However, there are situations when various kinds of complications occur, causing the development of an inflammatory process in the area of ​​​​the suture, ligature fistulas. This phenomenon has an infectious-allergic nature of rejection and rejection of material alien to the body.

Ligature fistula after surgery may develop:

• In an infected state, the ligature itself
• In case of non-compliance or violation of the rules of asepsis during the operation
• When the ligature is infected with the contents of the wound
• With imperfect processing of the postoperative site and the penetration of infection into the suture area

The development of the inflammatory process is influenced by the state of the patient's immune system; aggressiveness, the infectious ability of the microorganism that causes it; allergic reaction of the body.

The formation of ligature fistulas is characterized by:

• Diverse localization in the postoperative area, in any tissue layer
• Delayed temporary nature of the manifestation, from several days, weeks, months, years after suturing
• Various degrees of severity of the inflammatory process - from a local area with rejection of the suture material and healing of the fistula to long non-healing inflamed areas throughout the suture
• Independence from the material from which the non-absorbable ligature is made (silk, nylon, lavsan)
• Various consequences for the patient - from quickly healing, and practically not causing concern to a constant source of infection, causing intoxication of the body, which can lead the patient to disability

Postoperative complications in the form of ligature fistulas are inflammatory processes caused by infection in the areas of sutures.

Visually, the vaginal-rectal fistula is presented in this video.

Symptoms and Diagnosis

The formation of a ligature fistula is accompanied by certain events:

• The formation of local compaction, granuloma, in the area of ​​​​the surgical suture, hyperemic, often hot to the touch
• With a deep location of the fistula, the granuloma is not palpable on palpation.
• As a rule, the size of the inflamed area has a limited size.
• The formation of compacted areas may be accompanied by painful sensations
• The formation of a hole, a fistulous canal, on the reddened compacted area, through which the purulent contents are separated, abundant or insignificant
• In some cases, in the opening of the fistulous passage, you can see the end of the ligature, larger or smaller in size
• The fistulous canal can close, after some time open again
• Complete closure of the fistula opening occurs after removal of the infected ligature.

The formation of a ligature fistula may be accompanied by a significant increase in body temperature, up to 39 degrees

Detection of a fistula, as a rule, does not cause difficulties.

To confirm the diagnosis of "ligature fistula after surgery", it is necessary to perform the following measures, which are carried out by the surgeon.

Diagnostics:

• Examination of the patient, assessment of the inflamed area and fistulous canal, palpation of the granuloma
• Analysis of patient complaints, study of his medical history, data on surgical operations performed
• Probing the fistulous canal and assessing its depth
• Carrying out various methods of studying the fistulous canal using dyes, x-rays, ultrasonic methods of analysis

You should consult a doctor as soon as possible in case of the appearance of the listed symptoms, do not make independent attempts to treat the wound or remove the ligature from the fistulous canal.

Timely diagnosis of the ligature fistula will allow you to immediately begin its treatment.

Ligature fistula: treatment

Fistula treatment is carried out without fail in a medical institution by a qualified surgeon. Self-medication and treatment of the inflamed area in non-sterile conditions are fraught with additional infection and complication of the condition.

Waiting for the exit of the thread and the breakthrough of pus without medical intervention is also dangerous, since it can lead to the development of phlegmon, suppuration of neighboring areas.

Therapeutic measures can be carried out both by conservative methods and by more radical, surgical ones.

In the course of conservative treatment, measures are taken to eliminate the infection in the inflamed area, as a result, the opening of the fistula is closed.

For the treatment of the site of the fistula, antiseptics, antibacterial drugs, solutions of bactericidal indiscriminate action are used.

Treatment is accompanied by the appointment of antibiotics, anti-inflammatory drugs, immunomodulators, vitamins.

Unfortunately, cases of re-opening of the fistula are not uncommon if the ligature remains unremoved.

Methods of surgical treatment are aimed at removing the infected non-absorbable suture material from the fistula.

It is removed as follows:

• Under operating conditions, the surgeon cuts the tissue in the area of ​​​​the fistula in order to release pus
• Cleansing and washing the wound
• Steps are taken to blindly remove the suture
• If successful, this will lead to the final closure of the fistula
• If the attempt is unsuccessful, it will be repeated after a while, until the thread is successfully removed.
• The expansion of the dissection zone is fraught with infection and its spread to neighboring areas
• Sometimes attempts are made to remove the ligature using special surgical instruments without performing tissue dissection, through the fistulous canal
• And in case of successful removal of the thread, and in case of failure, the wound is treated with antiseptic preparations; the wound is bandaged; treatment is carried out for the required period while monitoring the condition of the wound

Methods have been developed to remove the thread, carried out using ultrasonic control methods. The advantages of such modern techniques are the directed actions of the surgeon and a more gentle procedure for the patient.

If there are several fistulas along the postoperative suture, an operation is performed to excise the affected area with the removal of the ligature.

A necessary condition for the effective treatment of a ligature fistula is the patient's full awareness of the steps taken and the processing methods used.

Prevention

Preventive steps to prevent postoperative complications in the form of ligature fistulas are performed and entirely depend on the surgeon.

Prevention measures:

• Strict adherence to the principles of asepsis and antisepsis
• Checking the suture material prior to its use - the tightness of the package, expiration date, confirmation of sterility
• Thorough wound preparation with antiseptic treatment before suturing
• The use of modern suture materials at the final stage of surgical intervention; avoiding the use of non-absorbable silk sutures whenever possible

The implementation by the surgeon of preventive measures to prevent postoperative complications will reduce the percentage of inflammatory diseases in patients.

Awareness of patients about possible complications after surgery will allow them to detect their symptoms in time if they occur and seek medical help in a timely manner.

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How is a fistula that appears after surgery treated?

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 canal at the same time 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 with 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.

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Fistula after surgery: how to treat?

It often happens that an infection that progresses inside is looking for a way out. This is especially true after surgery. Consider why this happens and how a fistula that appears after surgery is treated.

Fistula - what is it?

A fistula is a channel that connects body cavities or hollow organs to each other or to the external environment. It is lined with epithelium, and pus comes out through it, or the channel is lined with granulation tissue. If this does not happen, then a purulent fistula is formed.

Such a process may be the result of some inflammatory process in the body or a consequence of surgical intervention.

Types of fistulas

Depending on where the fistula is located, they are divided into:

The fistula may be complete or incomplete. The full one has two holes and is treated faster, as it has a way out, while the incomplete one, having one hole, further develops the inflammatory process, the number of bacteria increases.

The fistula can be labial or tubular. The labioform is treated only with the help of surgery.

If we consider the process of formation, then the granulating fistula is one that is not yet fully formed, and the tubular fistula is already lined with epithelium and is fully formed.

What are the causes of a fistula after surgery?

There are several reasons for this phenomenon:

1. The source of infection has not been completely eradicated.
2. With a chronic protracted inflammatory process.
3. Like the consequences of a blind gunshot wound. Small particles in the body, fragments are perceived by the body as a foreign body, and the process of suppuration begins.
4. Denial by the body of the threads used in surgical operations, as a result, the sutures fester.

The last point is the most common reason why a fistula appears after surgery. There are also several explanations for this:

• Non-sterile suture.
• The reaction of the body to a foreign body.

The fistula at the suture after the operation forms a seal of the suture itself, fibrous tissue and collagen fibers.

How to recognize the appearance of a fistula after surgery?

Since this is primarily an inflammatory process, it is not difficult to recognize a fistula after surgery by its characteristic symptoms. They are:

1. Around the seam in the infected area there is a thickening, redness, bumps, and here the body temperature is much higher.
2. As a rule, at the initial stage, not the entire area of ​​the postoperative suture is inflamed.
3. There are purulent discharges. The rarer, the more of them.
4. The affected area is red, swollen and painful to the touch.
5. The suture site becomes red.
6. The general condition of the patient may worsen, the body temperature rises to 38 degrees and above.

If you have these symptoms, you need to urgently see a doctor, otherwise the infectious process may spread to the organs or cause blood poisoning.

Fistula Diagnosis

It is not difficult to diagnose a fistula after surgery, since it can be seen visually if it is external. The doctor, after listening to the patient, examining, pays attention primarily to:

• Quantity and quality of secretions.
• On the size of the fistula, its color.
• If the fistula is interorgan, then pay attention to the work of neighboring organs, especially if there are changes.

In order to find out the length and direction of the fistulous canal, probing and radiography are used.

It is also necessary to do a series of tests that will confirm the type of fistula. Gastric will show the presence of hydrochloric acid, and urinary - the presence of uric acid salts.

It happens that the seam may begin to fester after a long time after the operation, so you need to find out the cause of this phenomenon.

If a fistula still appears after surgery, how to treat it?

Fistula treatment

For successful therapy, first of all, it is necessary:

1. Eliminate the source of the inflammatory process. If it is a thread, then it is removed.
2. The doctor should conduct an examination, make a fistulography. This will show if the fistula has a connection with the internal organs.
3. Then a mandatory course of antibiotics or anti-inflammatory drugs is prescribed, depending on the depth of the inflammatory process.
4. To maintain the body, the doctor may prescribe a vitamin complex so that there is more strength to fight microbes.
5. The wound is washed with a syringe with hydrogen peroxide or a solution of furacilin, as these agents perfectly disinfect and promote rapid healing. The procedure is carried out daily, and if there is a lot of pus, then several times a day.

As a rule, the wound begins to heal. If this does not happen, then surgical intervention is possible, in which excess granulations are removed, and cauterization of the sites is possible.

The latest method is the treatment of a fistula after surgery using ultrasound. This method is considered the most gentle, but it is not the fastest.

In severe cases, if several fistulas have formed, excision of the postoperative scar is shown completely. The infected suture is removed and a new suture is placed.

Postoperative intervention

If you still failed to cure the fistula and had to resort to surgical methods, then after the operation to remove the fistula, healing will take place within a few weeks. The wound will heal faster if you provide it with complete rest and proper care.

After rectal fistula surgery, the doctor usually prescribes a diet so that the wound heals faster. After such operations, it is necessary to prescribe painkillers and antibiotics. The wound heals within a month, any physical activity is excluded.

The treatment prognosis is generally good and the patient makes a full recovery.

Folk methods of treatment

Of course, people are always trying to cure the disease at home. There are several recipes for the treatment of fistulas with folk remedies. Here is some of them.

1. It is necessary to take vodka and olive oil in equal proportions. Wet the bandage with this mixture and apply to the inflamed area. Apply a cabbage leaf at night. Such procedures require at least ten.
2. Well draws pus from the wound a mixture of aloe juice and mummy. Shilajit is diluted with water to the consistency of strong tea. The bandage must be left for a long time.
3. It is advised to wash the wounds with a decoction of St. John's wort. You can put a bandage on top, and then wrap it with oilcloth. If the solution is hot, then the effect of it will be greater.
4. There is a recipe for an ointment that treats not only fistulas, but also non-healing wounds. It is necessary to take equal amounts of flower honey, pine resin, medical tar, butter, aloe leaf pulp, mix the ingredients and heat in a water bath. Dilute with vodka to desired consistency. Apply ointment around the fistula, then cover with polyethylene and apply a bandage or plaster. The fistula will heal literally before our eyes.
5. It is good to apply softened resin. It perfectly draws out pus and heals wounds.
6. To strengthen the patient's immunity, it is recommended to drink aloe juice with honey. The recipe is as follows: you need to take 12 leaves from a three-year-old plant and leave it in the refrigerator for 10 days. Then finely chop, put in a glass dish and pour liquid honey so as to completely cover. Stir every day, and insist for 6 days. Strain the infusion and consume 1 teaspoon 3 times a day before meals. After such a drug, strength appears to fight the disease, and wounds will heal faster.

It is worth noting that if a fistula has formed after the operation, then the treatment should take place under the supervision of doctors, and folk remedies are an addition to the main course.

Fistula Prevention

In order to prevent fistulas from appearing after surgery, it is necessary:

• First of all, observe the rules of asepsis during the operation.
• All instruments and suture material must be sterile.
• It is necessary to carry out the treatment of the wound before sewing it up.
• Alloying of vessels should occur with a small capture of tissues.
• Prescribe antibiotics to prevent infections.
• It is necessary to treat all infectious diseases, preventing the development of fistulas.

Postoperative is a fairly common complication that can form for various reasons. As a rule, a fistula is formed after surgery on tubular organs or during abdominal operations. This purulent channel may not heal for a long time and lead to damage to the body in different places, and sometimes even to the formation of malignant tumors. It is evidence that a serious inflammatory process is taking place in the body.

A fistula on the leg after surgery usually develops due to eventration, suppuration of surgical scars, if the suture material becomes contaminated and infected with pathogenic microorganisms. A seal (granuloma) is formed around the fistula, which consists of a ligature thread and cells with fibrous tissue, macrophages, collagen fibers, etc.

Most often, fistulas are formed due to the use of silk threads.

Any operation can be the reason: with a leg fracture, muscle injury, etc.

The fistula may not form immediately, but several months or even several years after the operation. Usually develops in conditions of reduced immunity.

Symptoms

With the development of a fistula, the symptoms are very pronounced and pronounced. The most obvious signs include:

• seals and hot tubercles (granulations) form around the infected suture;
• the scar becomes very inflamed;
• pus is released from the wound in small or large quantities;
• this place is much redder than the surrounding tissues;
• edema forms in this place;
• pain in the affected area of ​​the leg;
• body temperature rises to 39 0 C.

Why are fistulas dangerous?

If suppuration does not go away for a long time and reaches a large size, an abscess may begin. In this case, general intoxication of the body may occur, which can lead to any consequences up to disability.

Also, do not start the process so that it does not become chronic.

The constant discharge of pus can lead to the development of dermatitis.

Treatment

Treatment of a fistula on the leg after surgery may not be required if the ligature thread comes out on its own. But you should not hope for this, and with the formation of a fistula, you should immediately seek help from a doctor.

Most often, the treatment consists in removing the festering ligature thread, after which a course of anti-inflammatory therapy and antibiotics is carried out. You also need to take vitamins and drugs to increase immunity. In order for the wound to heal faster, it is washed with a solution of furacilin or hydrogen peroxide to ensure disinfection.

In addition to removal, cauterization of the wound is carried out and all purulent granulations are carefully scraped out.

Treatment of fistulas with ultrasound is also practiced. This is a more modern and gentle method.

With the formation of several fistulas, the wound is opened, washed and new stitches are applied.

Prevention

Prevention should be done by the surgeon during the operation. He is obliged to comply with all security measures to ensure sterile conditions for the operation. The suture material must be clean and sterile, and the wound must be washed.

New modern self-absorbable threads, such as Dexon or Vicryl, are also good in this regard.

Each operation is a serious risk for the body. Currently, doctors are trying to carry out most surgical interventions with minimal suturing of the wound area. However, even with careful observance of all the rules for caring for the operating area, complications such as ligature fistulas may occur. According to statistics, every tenth patient of working age and every fifth pensioner face them. That is why it is necessary to know the first symptoms of the onset of the disease, as well as pay great attention to the rules of prevention. So you can protect yourself and your loved ones from the development of such complications.

What is a ligature fistula

A ligature fistula is an inflammatory cavity formed after surgery, in which there are purulent masses. Almost all surgical procedures involve damage to the patient's soft tissues. To close the resulting defect and ensure the immobility of the edges of the wound, doctors use special sutures. The threads that are superimposed on the damaged area are called ligatures. Unfortunately, such an intervention is often complicated by the addition of an inflammatory process.

How long after surgery does the disease appear?

A ligature fistula can develop in the early postoperative period (in the first seven to ten days after the surgical intervention). Moreover, its occurrence is associated with infection of the suture material. If the fistula is formed in the late postoperative period (on the eleventh day and later), then these are the consequences of defects in care and dressing.

What types of surgical intervention provoke the development of a ligature fistula

Such a pathology may occur against the background of the following operations:

1. Appendectomy. This is a surgical procedure to remove the appendix of the cecum, which is located in the right side of the abdomen just above the pubis.
2. A caesarean section is a procedure for removing a baby from the mother's body. In this case, the incision is located directly above the pubis, and doctors sequentially dissect the skin, fatty tissue, muscles and uterus. The danger of developing a fistula after this operation is that the pus directly enters the reproductive organs and can cause infertility.
3. Mammoplasty is a surgical intervention aimed at increasing the size of the breast. Through the incision, which is located under the breast, in the area of ​​the nipple or armpit, a silicone implant is inserted.
4. Episiotomy is an operation to cut the perineum. Used in difficult childbirth (multiple pregnancy, large child).
5. Nephrectomy is a surgical procedure in which the kidney is removed. In this case, the incision is located in the lumbar region, as a result of which the wound is almost always subjected to a greater load.

Photo gallery: the location of the seams after various operations

A caesarean section is one of the most difficult operations in which a large incision is usually made.
With mammoplasty, a ligature fistula is often formed under the breast. After surgery to remove the appendix, the suture is located to the right of the midline

What is ligature infiltrate and ligature granuloma

A ligature granuloma is an inflamed area of ​​tissue that is limited from the surrounding organs by a protective shaft. Its formation is associated with a massive growth of the connective tissue substance, which fills the entire space of the defect.

Ligature infiltrate is a cavity inside which altered cells and inflammatory fluid are located. And it is also possible the presence of pus, blood and other foreign matter.

Causes of the appearance of a ligature fistula

A similar pathology develops after bacterial microorganisms enter the wound. Most often it is staphylococcus, streptococcus or Pseudomonas aeruginosa. However, the following factors from the organism and the environment also take part in the formation of the ligature fistula:

• hypothermia or overheating in the sun;
• infection of the suture material;
• insufficient disinfection of the skin during the operation;
• transferred bacterial or viral diseases (colds, SARS);
• extremely low or too high body weight;
• the presence of malignant or benign formations;
• an allergic reaction to the components of the threads;
• advanced age of the patient;
• condition after childbirth;
• malnutrition with a lack of proteins or fats;
• other injuries.

How does the formation of such a pathology manifest itself?

The symptomatic picture of the development of a ligature fistula is quite typical and does not differ in a special variety of signs. A few days or weeks after the operation, the victim begins to feel pain in the wound area. Often it is accompanied by swelling and redness: the seam looks swollen, the threads change color. The skin becomes hot and bright pink, leaving a white imprint when pressed.

After a few days, hemorrhages appear in the area of ​​​​damage in the form of large and small bruises. Along with this, the nature of the discharge from the wound changes: from yellowish, colorless or bloody, it becomes purulent. In this case, the color changes to green, and an unpleasant odor arises, which is provided by existing bacteria. Patients complain of severe soreness and an increase in the amount of discharge with pressure. The skin near the affected area acquires a dense edema, becomes hot and tense, the sutures can erupt and injure the surrounding tissues.

Chronic and asymptomatic course of such a pathology is quite rare. Most often it occurs in older people, which is associated with a violation of the rate of metabolic processes in the body.

With a more severe course of the disease, the symptoms of general intoxication gradually increase:

• nausea and vomiting not associated with meals;
• and dizziness;
• loss of appetite;
• rise in body temperature to 37–40 degrees;
• decrease in working capacity;
• increased fatigue;
• sleep disturbances due to pain and frequent awakenings;
• nervousness, irritability and other changes in mental state.

In some cases, there is a tear of the purulent channel and self-cleansing of the wound. So you can see the formed passage - fistula. At the last stage, the formation of such an ailment can be complicated by the addition of massive bleeding from damaged vessels. The patient's condition is rapidly deteriorating, he loses consciousness and needs immediate resuscitation.

Methods for diagnosing a disease

An experienced doctor will be able to suspect the development of a ligature fistula in a patient at a glance. To do this, he only needs to examine the area of ​​damage and assess the condition of the seams. However, in order to prescribe treatment, it is necessary to obtain more complete information about the size and course of the fistula, as well as find out which microflora caused its development.

What treatments help get rid of the disease

Ligature fistula is a pathology that is prone to frequent recurrence. That is why therapy lasts an extremely long time and requires a responsible attitude not only from the doctor, but also from the patient himself. At the initial stage, doctors prescribe local medications for external wound treatment. In this case, the patient needs to appear every two days for dressings or show the suture to the attending physician at least once a week (when it is not possible to constantly travel to the hospital). If the pathological process continues to progress, more general drugs are prescribed that affect the state of the whole organism. Surgical intervention is performed in the absence of positive dynamics from conservative treatment within one and a half to two weeks.

Do not forget that with a second operation there is also a risk of a ligature fistula. It is necessary to care for the wound according to the same principles as for the primary surgical intervention.

Medical therapy for pathology

Treatment of a ligature fistula with conservative means consists in the use of local and general pharmaceutical preparations. They allow not only to get rid of the symptoms of the disease, but also to completely eliminate the cause that provoked the development of the disease.

Remember that without medical prescriptions, the use of any medication is strictly prohibited. In my practice, I have encountered a patient who independently began to take antibacterial agents without reading the contents of the instructions. He also suffered from cardiovascular disease, for which there is a rather limited list of drugs that can be used. In an effort to recover faster, the patient also repeatedly exceeded the dosage of the antibacterial drug. This led to the development of serious complications: the man fell into a coma, from which he had to be taken out by the doctors of the intensive care unit. The situation ended happily, but the victim became deeply disabled as a result of his experiments. That is why doctors advise very carefully approaching the choice of drugs.

Means for local treatment of ligature fistula:

1. Antiseptic solutions are designed to treat the wound surface. They allow not only to remove the remnants of fat, blood, ichor and purulent secretions from the skin, but also kill most harmful microbes. For this purpose, Miramistin, Chlorhexidine, hydrogen peroxide, Furacilin, potassium permanganate are most often used.
2. Healing ointments that improve blood circulation and help accelerate regeneration processes. The most common means: Bepanten, Rescuer, Dexpanthenol, Pantoderm.
3. Anti-inflammatory gels reduce the severity of edema, allow you to fight itching and relieve pain. Most often used: Diclofenac, Nise, Nimesulide, Ibuprofen, Ketorol, Ketorolac.

Photo gallery: preparations for local wound treatment

Chlorhexidine helps to disinfect the wound surface
Dexpanthenol accelerates recovery processes Diclofenac is an anti-inflammatory drug with analgesic effect

Medications for general therapy:

1. Antibiotics have a pronounced antimicrobial activity and cause the death of all bacteria. For this purpose, use: Klaforan, Tetracycline, Vibramycin, Keiten, Augmentin, Unazine, Azlocillin, Zinnat, Aztreonam, Imipenem, Vancocin, Rondomycin.
2. Steroid anti-inflammatory drugs are hormones that reduce the effect of bacterial toxins on the body, relieve redness and swelling of soft tissues. It is permissible to use Hydrocortisone, Cortef, Laticort, Dexons.
3. Vitamin and mineral complexes accelerate healing processes and restore the body's need for certain substances. Most often used: Complivit, Calcium D3-Nycomed, Aevit, Vitrum, Supradin.

Photo gallery: drugs for systemic effects on the body

Augmentin is a broad spectrum antibiotic that kills bacteria. Cortef helps relieve inflammation Vitrum contains all the mineral elements necessary for the body

Surgical treatment of ligature fistula

Conservative therapy is not always an effective technique for such a disease. If the disease progresses steadily, doctors decide on the need for repeated surgical intervention. It is carried out under the following conditions:

• accession of purulent complications;
• a sharp deterioration in the patient's condition;
• lack of effect from conservative therapy;
• cutting through the suture.

Contraindications for surgery:

• the need to stabilize the condition of the victim;
• too old or too young;
• acute allergic reaction to the components of anesthesia.

The operation is carried out in several stages:

1. Doctors anesthetize the area of ​​the proposed intervention. The choice of anesthesia technique (general or local) depends on the location of the suture and its size. The surgical field is treated with alcohol and iodine solution.
2. Using a scalpel and tweezers, the old suture material is removed, while expanding the incision area. Next, doctors study the condition of the wound, the presence of purulent streaks and sores, if necessary, adds a dye (this allows you to determine the course of the fistula).
3. Using vacuum suction, surgeons remove accumulations of blood, lymph fluid, and areas of dead tissue. The formed fistula is excised with a scalpel.
4. Using another suture material, the formed wound is closed. If necessary, a thin rubber tube is placed in one of its corners - drainage, through which the contents flow. The sutures are closed with a sterile dressing with a healing ointment.

How to properly care for the place of suppuration

To avoid the attachment of a secondary infection and protect your body from the development of purulent complications, it is necessary to monitor the cleanliness of the wound. The first few days after the operation, the dressing and processing of the suture is done by a nurse under the supervision of a doctor. But in some cases, the patient has to take care of the surgical wound on his own from the very beginning. That is why the following processing steps must be observed:

1. Wash your hands with soap and water, then dry them with paper towels (this will help minimize bacteria). Disinfect your palms and fingers with an antiseptic.
2. Treat the skin around the wound with water and cotton pads. Alcohol-free gels can be used. If necessary, also wipe the skin with an antiseptic without touching the seams.
3. Carefully remove the bandage. It is necessary to do this with soft and unsharp movements, as jerks can damage surrounding tissues. If soaking with ichor and blood has occurred, it is allowed to soak the bandage in an antiseptic or in plain water.
4. Using a small gauze swab, evenly treat the surface of the seam. Try to remove dirt and dried blood. Continue rinsing until the wound is clear.
5. Apply a bandage with the ointment prescribed by the doctor and gently wrap it with an elastic bandage. At the same time, try not to overtighten the soft tissue.

What is strictly forbidden to do during the rehabilitation period:

1. Visit baths or saunas, bathe in a hot tub. Steam softens the tissues around the seam, as a result of which the threads are cut through and an even deeper fistula is formed. For the same reason, you can not apply a heating pad to the affected area.
2. Swim in public ponds, rivers and quarries. That water does not undergo special treatment and is the source of many harmful bacteria that penetrate even through the applied bandage. Swimming in pools is limited due to the presence of bleach, which disrupts the healing process of soft tissues.
3. Use alcohol-containing solutions for wound treatment without medical prescription. Such drugs not only kill bacteria, but also damage the smallest vessels, causing bleeding. That is why their use is strictly limited.

Video: dressing and wound treatment technique

Features of therapy of ligature fistula after various types of operations

Often, such a complication occurs after natural and artificial childbirth (caesarean section) or episiotomy. During pregnancy, a woman's body is under the influence of hormones, as a result of which soft tissues lose their former elasticity and undergo mechanical stretching and tearing.

According to statistics, every third childbirth ends with suturing the damaged perineum.

A feature of the treatment of this condition is the impossibility of using many of the usual medications, as they enter breast milk and can be transmitted to a newborn child, negatively affecting the state of his body. That is why doctors mainly use local therapy: the suture must be treated with an antiseptic solution several times a day, and the woman also needs to maintain the cleanliness of the surrounding tissues. Topical preparations do not penetrate into breast milk and do not affect the condition of the child. If the pathological process progresses, doctors prescribe antibiotics that have a minimal effect on the newborn: Amoxicillin, Erythromycin, Cefatoxime.

Treatment forecasts and possible complications of such a pathology

Soft tissue healing is a long and not always predictable process that can face a number of really serious complications. The duration of the recovery period largely depends on the age of the patient and his state of health. In children and young people, the ligature fistula heals within two weeks to three months, while in the elderly this period can take up to six months. Patients with diabetes mellitus, hypertension, cardiovascular diseases have a lower rate of soft tissue healing, as a result of which they have a significantly increased risk of developing secondary complications.

Important in the treatment of ligature fistula is strict adherence to hygiene and the rules for the treatment of postoperative wounds. While working in the department of purulent surgery, I had a chance to encounter a man who developed a serious complication in the form of attachment of bacterial microorganisms to the area of ​​the postoperative incision. As it turned out, the victim did not clean his hands before changing the bandage, and also periodically sealed it with a rough plaster. When it was separated from the skin, tissues were constantly traumatized, which complicated the healing process. The man was operated on and all elements of pus were removed, which greatly alleviated his condition.

What complications can occur in patients with ligature fistula:

1. abscess formation. This pathological formation is a massive accumulation of pus in the soft tissues, which is limited to the capsule. An abscess develops gradually: edema begins to form in the wound area, pain increases sharply. After a couple of days, a motionless red elevation above the skin surface is formed, which has a densely elastic consistency. When probing, softening is observed in its middle, the boundaries of which increase with time. Treatment of an abscess is carried out by opening it and excising the capsule. In addition, doctors prescribe antibiotic therapy.
2. The development of phlegmon. Unlike an abscess, this accumulation of pus has no boundaries in the soft tissues and can spread further along the course of the fatty tissue. Phlegmon melts nearby vessels and nerves, as a result of which the blood supply to the most important organs and systems is disrupted. Its danger lies in the fact that often the formation lies deep in the tissues, and it is quite difficult to detect it. Edema and redness can form only 4-7 days from the onset of the disease. You can get rid of phlegmon only with the help of surgery and the further intake of antibacterial drugs.
3. Blood poisoning. One of the most dangerous complications that all doctors fear is sepsis. When bacteria enter the systemic circulation from the area of ​​the ligature fistula, a cascade of pathological inflammatory reactions is formed, during which microbes enter all internal organs. As a result, their functioning is disrupted: the heart, kidneys and brain suffer the most. And also the leading mechanism of this condition is the thickening of the blood - it cannot normally pass through the vascular bed. Treatment of this pathology is carried out in the intensive care unit and intensive care with the help of detoxification, antibacterial and anti-inflammatory drugs.
4. The development of a scar at the location of the ligature fistula. Usually, the entire defect is filled with connective tissue, which has a different structure than skin and muscles. The scar can be quite rough and even interfere with certain activities. In order to prevent this condition, doctors use physiotherapy and healing ointments and gels.

Photo gallery: possible complications of the disease

The phlegmon of the leg can be located very deep and do not give other symptoms, except for edema. An abscess is a purulent formation with a capsule A scar is an overgrowth of connective tissue

How to prevent the development of a ligature fistula

Unfortunately, despite all the efforts of doctors, the problem of infection penetration into the surgical wound still remains unresolved. In order to prevent this pathological condition at an early stage, recommendations for individual and group prevention are developed annually. As part of the latter, practicing professors of medical universities organize lectures and open seminars on the period of rehabilitation of patients after surgery. There, anyone can get information not only about care, but also about recovery procedures.

While studying at the Department of Traumatology, I had the opportunity to participate in an event dedicated to the problem of the occurrence of a ligature fistula in the early and late postoperative period. To get the most detailed information, the doctors presented illustrative cases from their practice: a selection of patients aged twenty to eighty years who were not lucky enough to encounter such an ailment. In the course of the study, all victims were asked to fill out questionnaires containing questions regarding lifestyle, diet, and hygiene measures taken to treat the wound. As it turned out after analyzing the data obtained, about 20% of patients continued to abuse alcohol and did not follow the rules for cooking, 5% missed taking the necessary pills, and 40% performed bandaging at home, which increased the risk of infection from the environment. Doctors came to the conclusion that the vast majority of patients violated the rules for conducting the recovery period: this affected the formation of a postoperative fistula. Based on the data obtained, we have developed universal recommendations for the prevention of the development of such an ailment, the use of which helps to reduce the risk of its occurrence by several times.

How to protect your body from the formation of pathology in the postoperative period:

1. Long before planning a surgical intervention (if it is not an emergency), it is necessary to check for an allergic reaction to the components of the suture material. This can be done in the same hospital where the operation will be performed. To do this, ask the surgeon for samples of the alleged threads and take them to the allergological laboratory. There, the doctor, using cutaneous or intradermal tests, will reveal the presence of a pathological reaction. With redness, swelling and swelling of the skin, it is better to refuse to use this type of material. Currently, there are a huge number of suture threads: one of them is sure to suit you.
   The application test allows you to detect the allergen
2. Try to avoid stress and neuropsychic upheavals. During the recovery period of the body after surgery, even slight anxiety can cause a deterioration in the condition. It has been proven that during tension and stress, the internal glands of a person secrete hormones that slow down the processes of rehabilitation and healing of tissues.
3. Follow hygiene. Most opportunistic bacteria live on the skin even in a healthy person. Under normal conditions, with intact tissue integrity, they cannot enter the bloodstream and cause an infectious process. But in the postoperative period, the body becomes especially vulnerable, and the wound is the entrance gate for bacteria. That is why it is so important to keep clean surrounding tissues. It is recommended to wear loose-fitting clothing made from natural materials that will not cover the site of the postoperative incision or injure it in any way. In the morning and evening, it is necessary to treat the skin with water and detergents, while not touching the bandage.
   Antiseptic gel removes germs from the surface of the skin
4. Give up physical activity. Prolonged lifting and carrying of weights or exercising in the gym can cause the suture material to cut through the soft tissues, as a result of which the wound will open. This will not only increase the risk of infection, but may also lead to a second operation. That is why doctors forbid playing sports and lifting loads of more than one kilogram for several months after surgery. Once a stable scar is formed, you can return to unlimited training again.
5. In the period before and after the operation, try to adhere to proper nutrition. Popular vegetarian and vegan diets with no animal protein reduce the rate of soft tissue healing and lengthen the recovery process. During the rehabilitation period, the body needs to receive fats and carbohydrates in large quantities, and the calorie content of the diet should not be less than 2500-2700 units. Doctors recommend giving up fast food, fast food, carbonated drinks and packaged juices, as well as sweets. These foods slow down the body's metabolism and can adversely affect wound healing. Give preference to vegetables, fruits, berries, lean meat and fish, as well as cereals and cereals. You can restore the amount of protein and calcium in the body with the help of dairy products and special vitamin and mineral complexes.
   Dairy products are necessary for the nutrition of patients in the postoperative period

Postoperative ligature fistula is a common situation in surgical practice. If you find such a defect, you should not worry and worry once again: the modern system of medical care has long provided for the occurrence of such a situation. When the first signs of the development of the disease appear, do not self-medicate: it will be much more effective and reliable to contact the doctor who performed the operation. He will be able to accurately determine the cause of the ligature fistula and offer effective ways to deal with such a problem.

A fistula is a pathological channel connecting two hollow organs or a hollow organ with the external environment. In humans, a fistulous opening can form by itself or after abdominal surgery. Treatment of fistulas is a long and labor-intensive process that requires a highly qualified doctor and patient compliance with all prescribed recommendations.

Classification of fistulous openings

Origin:

1. Congenital - those that are diagnosed even in infants immediately after birth.
2. Acquired - are formed during the life of the patient.

In relation to the external environment:

1. Internal - the fistulous canal connects two internal hollow organs.
2. External - the fistulous opening creates a communication between the cavity of the internal organ and the external environment.

According to the histological structure:

1. Granulating fistulas - the walls of the fistula opening are completely covered with granulation tissue, granulations are constantly updated and grow.
2. Epithelial fistulas - the walls are lined with epithelial tissue, but the connection with the epidermis of the skin is not formed.
3. Labiform fistulas - the walls and mouth of the canal are lined with epithelium, which is connected to the epidermis of the skin, and therefore there is no defect on the skin.

By the nature of the separated:

1. Mucous.
2. Purulent.
3. Urinary.
4. Fecal.
5. Salivary.
6. Biliary.

There are also natural and artificial fistulas. Natural ones arise independently after surgery or as a result of purulent inflammation of the organ. Artificial ones are created by the surgeon as a temporary measure for nutrition or at one of the stages of treatment.

Causes

The main reason for the occurrence of natural fistulous passages is purulent inflammation of the internal organ or skin. When a foreign body or infection enters the cavity of an internal organ, inflammation and suppuration occur. As the number of purulent masses increases, the overlying layers gradually melt. As soon as inflammation passes to the upper layers of the skin, pus breaks out, which creates good conditions for maintaining inflammation and outflow of pus. Healing of the wound edges becomes impossible due to the constant circulation of exudate, which requires surgical treatment.

Important! In the vast majority of cases, a fistula occurs as a complication of surgery. The causes of postoperative fistulous passages are associated with suppuration of the suture material and infection in the wound cavity - this is the so-called ligature fistula. Both skin wounds and internal organs can become inflamed. The deeper the infection, the longer and more difficult it is to treat the fistula.

Signs and symptoms of postoperative and natural fistulous canals

The clinic is quite pronounced and is represented by the following symptoms:

1. An inflamed scar or roller is visible on the skin, hot to the touch, painful on palpation. The roller can appear in the area of ​​both intact skin and in the suture area.
2. In the center of redness and inflammation, a small hole is visible, from where a large amount of purulent masses and exudate are constantly separated.
3. The patient is concerned about the symptoms of intoxication: fever (up to 38-39C), headache, weakness.

Important! As a preventive measure for the formation of fistulas in case of inflammation of the postoperative suture or scar, you should immediately inform the doctor about this.

What is the danger of a fistula

Ligature and other types of fistulas support a constant inflammatory process in the body, which subsequently leads to the formation of an abscess, phlegmon and organ necrosis. In addition, intoxication persists for a long time, which depresses the immune system. The patient becomes more susceptible to various infections.

Fistula of the rectum

In clinical practice, fistulous openings passing through the wall of the rectum are most common. The mouth of the pathological canals can open on the skin (communicates the rectum with the external environment), into the vagina (communicates the rectum with the vagina), in the subcutaneous fat.

Fistulas of the rectum can form independently and after surgery.

• Independent formation occurs against the background of neglected untreated inflammatory processes (paraproctitis, hemorrhoids) and after a difficult birth, complicated by a rupture of the perineum of 3-4 degrees.
• Postoperative fistulas - after an incorrectly performed operation for hemorrhoids, paraproctitis.

Ligature (postoperative) fistula

It is a direct complication of the operation, it is formed with unprofessional suturing of the wound and with non-compliance with medical recommendations on lifestyle in the postoperative period.

The starting moment is the infection in the wound, as a result of which the seams become inflamed, suppurate. Softening and melting of the wound edges leads to the formation of an inflammatory capsule around the sutures. After a few days, the ligatures slip off, creating an artificial opening for the penetration of infectious agents into the wound cavity. Constantly maintained inflammation does not allow the edges of the wound to stick together, the fistulous course epithelizes over time - a full-fledged fistula is formed.

Fistulous passages of the rectum are usually classified by location. Allocate transsphincteric, extrasphincteric and intrasphincteric fistulas.

It's important to know! With good drainage and outflow of exudate, the symptoms of the disease may not bother the patient for a long time. The patient does not notice that he is ill.

Pain occurs only when pus accumulates in one of the pockets, subcutaneous tissue or in the rectal cavity. This causes symptoms of intoxication (fever, weakness), which further increases the pain. The skin of the perineum reddens, thickens. The patient cannot go to the toilet, sit and walk for a long time, as this increases the pain syndrome.

Fistulas after abdominal surgery

Operations on the abdomen are divided into abdominal (with penetration into the abdominal cavity) and superficial, minimally invasive (do not affect the abdominal cavity, surgical manipulations are performed on the surface of the abdominal wall). The most severe are deep postoperative fistulas that form after abdominal operations.

• Fistulas after appendicitis, intestinal obstruction, liver abscess belong to cavity fistulous passages. For several weeks, pathological anastomoses are formed that are painful. Treatment depends on the presence or absence of a purulent focus of infection in the wound. During the operation, old ligatures are removed, the walls of the fistulous tract are excised and new sutures are applied.
• Superficial fistulas connect the subcutaneous fat with the external environment and do not affect the abdominal cavity, and therefore their treatment does not cause great difficulties. This group includes fistulas that form after surgery for an umbilical hernia, a hernia of the white line of the abdomen. The treatment is one-stage, one-stage excision of suppurated tissues and skin plastic is performed.

External fistulas of the urethra

A common pathology of childhood is hypospadias. So in medicine they designate a congenital malformation in which the opening of the urethra is not located at the top of the glans penis, but on its lower surface. As a rule, the malformation is combined with other anomalies in the development of the genital organs, which requires a complex operation.

Fistula after hypospadias surgery is a common complication. The fistula connects the urethral cavity with the external environment, and therefore urination becomes impossible. Treatment of this pathology begins with minimally invasive techniques: cauterization with silver nitrate. Such treatment lends itself to fistulas of microscopic diameter. With the ineffectiveness of conservative treatment and in the presence of a large fistulous canal, an operation is performed.

Treatment

Treatment is only surgical. Patients are shown an operation, during which the walls and mouth of the fistulous canal are excised, after which the resulting wound is sutured. If the fistula connects the abscess cavity with the external environment, then the purulent focus is first sanitized, the wound is treated in an open way. The last stage closes the pathological anastomosis.

1. The fight against constipation - include as many vegetables, fruits and berries (prunes) as possible in the diet. Excluded irritating food, carbonated drinks, which contribute to the formation of constipation.
2. Hygienic procedures of the wound surface are carried out daily. Cleaning and disinfection of the seams must be carried out every day.
3. Heavy physical exertion, long sedentary work for at least three months are excluded.

Diet after fistula surgery

The main guarantee of successful treatment and prevention of recurrence of fistulas is the fight against constipation and facilitating the act of defecation. Any tension of the abdominal wall and an increase in intra-abdominal pressure contributes to the divergence of the sutures and the formation of a repeated ligature fistula.

The diet includes foods rich in fiber: vegetables, berries, fruits. Prunes, boiled beets, vegetable juices have a good laxative effect. Drink at least 2.5 liters of fluid per day. At the first sign of constipation, laxatives are taken.

Important information! To prevent constipation, all gas-producing foods (grain bread, cabbage, legumes, dairy products), carbonated drinks, spicy and other irritating foods are removed from the menu.

Dishes are steamed, vegetables are boiled. Such a diet contributes to the rapid recovery and healing of the postoperative scar.

Useful video: How does a fistula occur after surgery

Fistula recurrences

A recurrence of the disease occurs when the diet, hygiene rules are not followed, after heavy physical exertion or after prolonged sedentary work. The relapse is accompanied by the return of all the symptoms that previously bothered the patient. Treatment of recurrence is carried out in a surgical hospital. After the operation, it is necessary to carefully monitor compliance with the recommendations and lifestyle.