Anal Fistulotomy-Seton Placement

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SAMPLE EXCERPT
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PRE-PROCEDURE
INDICATIONS

Symptomatic fistula in ano

CONTRAINDICATIONS
  • Severe medical illness
  • Bleeding diathesis
  • Significant anal suppuration
EQUIPMENT
  • Anal retractor per surgeon preference
  • Standard general surgery set
ANATOMY
  • Anal canal
  • Rectum
  • Anal glands
  • Internal sphincter
  • External sphincter
  • Levator ani
  • Puborectalis
  • Intersphincteric space
  • Ischiorectal fossa

PROCEDURE
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The full content of this section includes:
  • Step-by-step text instructions for performing the procedure
  • Clinical pearls providing practical clinical tips from medical experts
  • Patient safety guidelines consistent with Joint Commission and OHSA standards
  • Links to medical evidence and related procedures

POST-PROCEDURE
CARE
  • Sufficient pain medications are important, as postoperative pain can be substantial.
  • Laxatives and stool softeners help to minimize pain with defecation and avoid constipation and straining, especially in the setting of narcotic pain medication use.
  • A gauze anal wick is placed at the end of surgery. This can come out if it becomes uncomfortable, or with the first bowel movement.
  • Gauze is also packed in the open portion of the wound. Once the patient is home, he or she need only cover the wound with gauze. Packing such a wound while the patient is awake is awkward and often painful, and provides minimal benefit.
  • Careful hygiene, including Sitz baths.
  • Close clinical follow-up for Seton tightening and wound management. Any bridging over the fistulotomy wound should be debrided.
COMPLICATIONS
  • Pain
  • Bleeding
  • Recurrence
  • Incontinence
  • Urinary retention
  • Urinary or reproductive dysfunction
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