METHOD FOR SURGICAL MANAGEMENT OF ANAL FISTULAS

摘要

FIELD: medicine.SUBSTANCE: direction of a fistulous passage and location of outer and inner mouths of fistula are determined. The fistulous passage is sanitated by means of a bulbous-end probe and washed with 3% hydrogen peroxide. The fistulous passage is exposed to circular laser light emitted by a diode laser at wavelength 970 nm and power 25 Wt. The light guide is delivered along the fistulous passage up to the inner mouth of fistula. The laser light supply is pulsed: 6 pulses of the power of 14 Wt and pulse duration 900 ms and pulse separation 10 ms. Keeping the pulse supply, the light guide is pulled 3-5 mm in the distal direction; and the exposure cycle is repeated. The exposure is terminated at 5-10 mm to the outer mouth of fistula. The light guide is removed. The inner mouth of fistula is closed with a two-row catgut suture. Tissucol Kit fibrin filling glue is introduced into the treated passage. The outer mouth of fistula is closed with a catgut interrupted suture.EFFECT: method provides the minimally invasive treatment of the patients suffering rectal fistular by preventing anal sphincter insufficiency, local pyoinflammatory complications and a risk of postoperative recurrences.1 ex