Anal Fistulas is a pathology linked to proctological surgery.
Fistulas and abscesses appear in several successive stages. The initial phase corresponds to the infection of a gland, located in the upper part of the anal canal, called the crypt of MORGAGNI. The second stage is suppuration, which spreads through the tissues and muscles surrounding the anal canal, and opens to the skin surrounding the anus to give an abscess. DEFINITION
Contents
- DEFINITION
- Rectum diagram
- SYMPTOMS
- DURING HOSPITAL ADMISSION
- The day before the operation
- The day of the operation
- The operation
- Uncover the orifice of the anal fistula in the anal canal
- Follow-up chirurgico
- Recovery phase
- AFTER THE INTERVENTION
- Return to the ward
- Homecoming
- Consequences and complications
- Long-term monitoring
Anal fistulas and anal margin abscesses are the same disease that begins with the infection of small glands in the anal canal. The abscess is acute and is always the result of an underlying anal fistula. Diagram of the rectum
Diagram in cross section of the anal canal. The canal is surrounded by 2 muscles that ensure anal continence (SI: internal sphincter, SE, external sphincter). Left, a low anal fistula, responsible for an abscess of the anal margin. On the right, a high anal fistula, which is responsible for chronic suppuration (note that a low fistula can also become chronic, and a high fistula can form an abscess). SYMPTOMS
The abscess is manifested by the appearance of a small, highly inflammatory red ball that appears around the anus. This swelling is very painful and prevents the patient from sitting down. It can be accompanied by fever.
The fistula is painless and usually reveals itself as a permanent discharge of pus around the anus. The onset of pain heralds the formation of an abscess of the anal margin. This abscess can drain on its own and the pain will disappear on its own. However, more or less quickly, a new identical outbreak will occur.
Clinical examination reveals a small ball around the anus, from which pus comes out. Most often, the patient has a small scar from the previous incision of an abscess. Sometimes palpation of the area around the anus will reveal a small hard cord that corresponds to the path of the fistula.
More often than not, no way can be found on clinical examination and surgery is needed to find the way. Finally, in some difficult cases of very deep fistulas or recurrent fistulas, further radiological examinations (pelvic MRI) will be required. DURING HOSPITAL ADMISSION
The treatment of anal fistulas and abscesses of the anal margin is always surgical. In fact, healing will only be achieved when the path of the fistula is recognized and removed. In no case can antibiotics alone treat the disease. The day before the operation
The only possible preparation done sometimes is a small gentle enema to clean the rectal ampoule. On the day of the operation
The patient is given a pre-dressing a few hours before the operation. The operation
The operation is usually performed under general anesthesia.
The operation lasts on average about ten minutes in usual cases.
In phase ABC, the fistula is incised, pus is evacuated and, if possible, the primary orifice is found in the anal canal, which is the starting point of the fistula.
If the fistula route is superficial, treatment of the abscess and fistula can be performed during the same procedure.
On the other hand, if the path of the fistula is too deep, passing through the muscles used for anal continence, it is preferable to treat only the abscess and to treat the fistula only at a later stage. Of course, the patient will always be warned of this possibility before the operation.
IN THE ANAL PHASE OF THE FISTULA, the goal of surgical treatment is the removal of the fistula path, but this treatment must obey 2 imperatives:Uncover the orifice of the anal fistula in the anal canal
To ensure the functional integrity of the anal continence muscles, located around the anus.
This is why patients sometimes keep an elastic tie around the anus for a few days to allow the muscles to heal and thus avoid any subsequent incontinence problems. Surgical follow-up
The purpose of this phase is to monitor the absence of complications for a return to a normal state. The first phase takes place in the recovery room, then during the hospitalization and finally during the convalescence at home. Recovery phase
When the operation is over, they are transferred to the recovery room for a minimum of 2 hours. Your state of consciousness, pulse, oxygen saturation and breathing will be monitored. AFTER THE OPERATION Return to the ward
On the evening of the operation, you will be discharged. You will be hospitalized for 24 hours. You will resume eating on the evening of the operation and the next day in a completely normal way. The dressing is monitored. The resumption of intestinal transit marked by the emission of gas occurs very quickly in the hours following the operation. Homecoming
While recovering, you can eat normally. There is no need to give a special diet. You will be systematically prescribed painkillers and treatments to facilitate intestinal transit. Consequences and complications
Complications have become exceptional today when the surgeon is careful to respect the different operating times for flattening the fistulas. The possibility of treating abscesses in two stages must always be explained to the patient.
However, the existence of a very large abscess can lead to secondary problems of anal continence. Treatment, usually physiotherapy, is then undertaken and only in extreme cases will surgical treatment be performed for the
The recurrence of anal fistulas is always possible and raises the problem of the so-called complex anal fistula. These cases require additional radiological examinations, such as pelvic MRI, to look for unusual pathways of the fistula. Long-term
monitoring No special monitoring is required, apart from the usual post-operative consultation which takes place 1 month after the operation.
