Fistula in ano and TEM痔疮肛门和TEM瘘ppt课件.pptVIP

All possible mucosal tissue must be preserved to prevent stenosis. However, relatively large areas of skin may be safely removed in the triangular incision. With extensive hemorrhoids it may be necessary to excise one-half of the mucosa of the entire canal in this fashion. The triangular incision may extend from the anal verge and reach the pectinate anteriorly and posteriorly. The mucosa is divided horizontally, taking small bites of tissue in a series of hemostats This mucosal flap is sutured into the external sphincter horizontally to prevent stenosis All redundant incisional skin margins should be excised to minimize the subsequent development of potentially damaging perianal skin tabs. Post Op care A sterile protective dressing is applied to the anus. Petrolatum may be applied locally. The patient is encouraged to have a bowel movement and usually will do so by the third day. Local application of heat is useful in alleviating discomfort. The patient may take sitz baths as desired. Weekly anal dilatation may be needed postoperatively until healing is complete. Treatment of Thrombosed Hemorrhoids Thrombosed external hemorrhoids may be removed in the patient who is ambulatory. The anus is cleansed, and local anesthesia is administered by injection over the surface and just beneath the thrombosed hemorrhoids. An elliptical incision is made over the thrombosed area, and the clot is removed by finger compression or by introduction of a small curette This excision leaves no redundant scar tissue, and final healing occurs without tab formation. Gentle dissection of the clot causes no bleeding it should not be necessary to suture the wound. Rarely, a suture of fine absorbable suture may be necessary. The patient may return home immediately. Drainage of Ischiorectal Abscess Indications Ischiorectal abscesses are drained immediately. Careful palpation often shows evidence of fluctuation not seen in the perianal tissue. Operation is not delayed until fluctuati