ABSTRACT:

to get one stage operative procedure we are away from complications it takes ashort time for healing no forign boy reactions it depends on closing the suprashentric part of the fistula with askin flap not containing epidermis and fat using anearbye pedicle flap

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Keywords – perianal fistula,surgery,new technique,pedicle flap

INTRODUCTION

There is a problem in solving the difficulty of high perianal fistula because there are complications after the old operative procedure as recurrence , incompitance and multiple stages .

In our new technique we solved this problem in a one stage without comlications by plugging the fistulus tract with a normal nearby skin devoid of epidermis and fat.

1.Pre operative preparations:

                 (NPO) 4 hours before surgery then shaving of the operative area at the time of operation and cleaning the area with anti-septic solution

2.Anaesthia
                spinal or epidural

3.Steps
a-lithotomy position
b-fistulotomy of the extra sphentric fistulus part by fine needle cautarization probe
c-inject methelene blue by canula in the external orifice of the remaining supra-sphentric fistula
d-introduce a proctoscope to identify the internal opening
e-introduce an anyrisemal needle from the rxternal to the internal opening
f-cauterization is done over the needle to destruct the endothelail lining of the tract
g-extract the neelde and wash the tract with H2O2
h-take a near-by skin flap with apedicle and remove its epidermis and fat
i- re-insert the anyresmal needle and thread its tip with avicryl thread 2/0 then extract the needle with the thread
j-ligate the tip of the flap with this thread then pull the thread from outside to inside taking the flap with it to plug the tract
k-suture the mucous membrane of the internal orifice of the tract pluging it with the tip of pedicle
l-pass a thread under the pedicle of the flap to identify its site later on

                        4.Figures
   4.1 Exicsion of the extra sphentric part of the fistula

4.2 fistulotomy of the extra sphentric part

4.3  introducing anyresmal needle in the supra-sphentric part

4.4 performing anear-by skin flap

4.5 suturing the tip of the flap to the internal opening of the fistula

5.Follow Up
1-dressing daily with anti-septic solution
2-anti-biotics
3-oral fluids for 3 days
4-simple analgesia

6.Conclusion

18 patients were admitted to a central and special hospital for treatment of a high peri-anal festula by this new technique
-12 of them were cured with no recurrence cases
- 4 of them were cured with recurrence after 18 months
- 2 of them under following up

References

1-Sainio P: Fistula-in-ano in a defined population. Incidence and epidemiological aspects. Ann Chir Gynaecol 1984, 73(4):219-24.

2-Marks CG, Ritchie JK: Anal fistulas at St Mark's Hospital. Br J Surg 1977, 64(2):84-91.

3-Parks AG: Pathogenesis and treatment of fistula-in-ano. Br Med J 1961, 1(5224):463-9.

4-Parks AG, Gordon PH, Hardcastle JD: A classification of fistula-in-ano. Br J Surg 1976, 63(1):1-12.

5-Ortiz H, Marzo J: Endorectal flap advancement repair and fistulectomy for high trans-sphincteric and suprasphincteric fistulas. Br J Surg 2000, 87(12):1680-3.