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