SLOFT (Submucosal Ligation Of Fistula Tract)

Dr D.U.PathakWhatsApp 94251-52747

Email : sloftsurgery@gmail.comShalby hospital, Jabalpur

(M.P) India

Inter sphincteric fistula at 2- O clock

• External opening at 2-O clock • Tract palpable up to 3

cms

Probing

• Gentle probing• Probe pulled out of anal

canal

Injection

• Inj Xylocaine adrenaline at muco cutaneous junction, just 1 cm beyond the internal opening, for hydro dissection and blanching

Incision

• At muco cutaneous junction

Dissection around the probe

• Dissection around the indwelling probe with artery forceps

• Passing an aneurysm needle and taking suture with it’s help

Tying the tract

• The probe is taken out and tract tied, transfixed

Transection

• Tract is cut near to the tie

• A lateral segment, which is infected crypto-glandular portion, is excised and sent for biopsy

Dye test

• 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

• 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

Perianal wound closed

• 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

External opening wound

• 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

Thanks...

I am happy with the results...