Fistula in anoWhy Unnecessary Wide Excision?

Peri-anal Fat is precious, Anal Musculature is complex and indispensible, So Why unnecessary and over enthusiastic excision of precious tissue?

Previous surgery with seton in situ – large isheorectal abcess right side

Case 1

Laying open of tract with seton placement

Incision and drainage of abscess – cavity communicating with internal opening

Probing

Case 2

External opening

Methylene Blue injection –

no external opening

Coring

Excision of tract till blind end – bone

palpable

Packing of wound

Case 3

Multiple external openings - Probing

Laying open tract

Anterior horse shoe type fistula – lay open –

internal opening at 6 o clock.

Seton placement – partial sututing of

open wound

Case 4

Coring of two external openings

Opening made at 6 o clock position

with seton placement

Case 5

MRI gluteal regionComplex grade V intersphintric

translevator perianal fistula with two external openings on right side and opening in translevator area on right side after crossing midline

Probing

Joining two external openings

Internal opening at 6 o clock

Lay open tract – seton placement

Is it avoidable?Yes I shall come up with

solutions in next presentation.