Several types of surgical intervention can be performed to treat paraproctitis. The choice of the operation will be determined based on:
- The course of the disease is acute or chronic.
- Places of localization and size of the abscess.
- The location of the fistula's progress in relation to the sphincter of the rectum.
In the case of acute paraproctitis, the operation is performed by removing the purulent mass, and the anal crypts and glands in which the inflammatory process begins.
However, the diagnosis of the situation can be different. With a precise knowledge of the location of the abscess, the purulent course, the inflamed anal sinus, and also if the surrounding tissue was not affected by the inflammatory process, a radical one-stage operation will be performed. As contraindications for performing such surgical intervention in paraproctitis are:
- Severe course of the disease and the patient's condition.
- Unknown location of the affected area of the anal sinus.
- Damage to tissues around the site to be treated.
Along with this, there are several options for carrying out a radical operation in the case of acute paraproctitis:
- The abscess is dissected and the purulent mass is excised. The sinus and the purulent duct are excised in the lumen of the rectum. This surgical treatment of paraproctitis will be performed by the laser if the stroke is located inside of the external sphincter, or if it is damaged, only its subcutaneous layer. Such surgical intervention helps in 70% of cases.
- The paraproctitis is opened and the purulent mass is removed. The anal sinus is excised and the sphincterotomy is performed. The implementation of this operation is possible in the case of the onset of the development of pathology in the inter-sphincter space. Due to this, it is possible to drain the abscess from the inter-spine to the space of the rectal cavity.
- The abscess is dissected and the excision of the contents is performed. Crypts are eliminated when a ligation for draining is applied. This operation with the use of a laser is required in the case of trans- and extra-sphincter paraproctitis. Thanks to this treatment, an excellent outflow for the content is created, after which radical intervention is allowed.
Another type of operations for paraproctitis with acute course are multi-stage. They are held more often. How do such an operation in paraproctitis? To begin with, an autopsy is performed and a purulent mass is removed. At the second stage, the affected area of the anal sinus and gland is removed. Such a stage will be performed one week after the opening of the abscess, and depends on the healing process of the tissues. In the event that the first stage can be carried out in a regular hospital, then the second stage is better performed in the department of coloproctology. The procedure of these operations in paraproctitis is similar to the first stage, but not one-time, but two-stage surgery will be performed.
Operations for chronic paraproctitis
The determination of the required surgical procedure will depend on the location of the fistula in relation to the rectum blockage apparatus. To date, in paraproctitis surgery, there is a large number of tools for such surgical intervention:
Operation with intra- and transsfincture fistula, occupying less than 30% of the sphincter. How do this kind of surgical intervention with paraproctitis:
- A dissection is performed and the fistula is excised into the lumen of the rectal cavity. The dissection is a cut of the fistula, that is, an opening, with the preliminary insertion of the probe. Excision is a complete removal of the course from the tissues. The result of such operations is positive in almost 90% of cases. This excision can be caused by the occurrence of complications, a long healing of the wound, and a greater risk for a disruption in the functionality of the sphincter.
- The fistula is filled with fibrin glue. First, the fistula cavity will be cleared of the contents, and then filled with specialized glue. Such an operation is very simple, easy to perform and low-traumatic, with a low risk of complications. The method is effective in 60% of cases.
Operation with intra- and transsfincture fistula, occupying more than 30% of the sphincter:
- Filling with fibrin glue.
- Application of sealing tampons, which are made from biological materials, based on the pig intestine. With this procedure, it is possible to close and heal fistula.
- Paraproctitis removal when the flap is removed from the rectal cavity. After opening the fistula, the opening of the stroke of the intestinal tissues is closed.
- Removal of the fistula when applying a ligature acting as a drain before performing a radical operation. Its use is possible for 6-8 weeks.
- Excision of the fistula and suture of the sphincter. As a surgical treatment for high fistula, a laser is used. The excision of the fistula is performed, the section of the sphincter that is affected by the fistula is dissected and then sutured. Efficiency of this operation is observed in 80% of cases.
- Overlapping and dissection of the fistula in the inter-sphincter area. From the side of the outer orifice, the fistula's course will be removed, and the rest, which is located in the inter-sphincter area, will be crossed and bandaged.
As you can see, today a large number of types of surgical intervention are presented with different individual characteristics. The current surgery does not stand still, which contributes to a painless and rapid elimination of paraproctitis in the future.