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Dr D.U.Pathak
Shalby hospital Jabalpur
External opening at
2-O clock
Tract palpable up to 3 cms
Gentle probing
Probe pulled out of anal canal
Inj Xylocaine adrenaline at muco cutaneous junction, just 1 cm beyond the internal opening, for hydro dissection and blanching
At muco cutaneous junction
Dissection around the indwelling probe with artery forceps
Passing an aneurysm needle and taking suture with it’s help
The probe is taken out and tract tied, transfixed
Tract is cut near to the tie
A lateral segment, which is infected crypto-glandular portion, is excised and sent for biopsy
After transecting the tract, dye is instilled from external opening, which comes out from perianal area instead of anus
Cotton squab in anus is seen without soiling with dye
Coring is done of distal tract if it is mature.
Otherwise only curetted, if it is an abscess fistula complex with tract not well formed
The external epithialised opening should remain patent to drain the infection
Should be left open with a small pack if inter sphincteric space is infected
If the tract was mature and total excision was possible then it can be closed primarily
Loose packing done for one day
No post op packing or dressings, only cleaning and warm sitz bath is enough
Post operative follow up after 15 days or SOS if patient has any problem
P/R and a check USG is done on 15th day to see for any collection if any and further visits decided accordingly
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