By Victor W. Fazio MBBS MS MD (Hon) FRACS FRACS (Hon) FACS FRCS (Ed) FASCRS OA, James M. Church MBChB MMedSci FRACS FACS, Conor P Delaney MCh PhD FRSCI ( Gen) FACS, Ravi P Kiran MD MBBS FRCS (Eng) FRCS (Glas) FACS
For greater than 25 years, Current remedy in Colon and Rectal Surgery has been the go-to source for getting ready for the yank Board of surgical procedure certification exam. Following during this culture, the third version bargains a accomplished, modern precis of treatments for colorectal illnesses, with a spotlight on useful medical technological know-how and functions. in one, moveable quantity, you’ll locate entire insurance of recent diagnostic modalities, clinical therapeutics, and surgery strategies, together with minimally invasive surgical procedure. effortless to learn and digest, it offers a quickly session with experts at the necessities of colon and rectal surgery.
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Extra info for Current Therapy in Colon and Rectal Surgery
Fistulotomy with opening and unroofing of Table 5-1 Types of Anal Fistula in 249 Cases* FISTULA Intersphincteric Trans-sphincteric Low High Suprasphincteric Extrasphincteric *Personal series. NO. OF CASES 149 70 46 24 25 5 PERCENTAGE 60 28 10 2 the fibrous portion of the tract and fistulectomy with excision of the tract are two options for relatively low transsphincteric tracks. Excision should be used when an obliterated tract is encountered or when a definite cord, lying superficially, is palpated.
NATURAL HISTORY OF THE DISEASE AND PATHWAYS OF SPREAD As infection of anal glands is the primary event for most anorectal abscesses, the intersphincteric plane is involved first, leading to an intersphincteric abscess. Spread of infection in a downward direction in this plane leads to presentation as a perianal abscess. When pus penetrates the external sphincter below the puborectalis and expands into the ischiorectal fossa, it may point further laterally as an ischiorectal abscess. From here, pus may track into the postanal space and into the opposite ischiorectal space, leading to the formation of a horseshoe abscess.
Recurrence or prolongation of pain may be associated with a hematoma or abscess. Gordon’s text is pessimistic concerning postoperative soiling and incontinence, but more recent articles described nearly no problems. Caveats include the following: 1. Do not cross the dentate line. 2. Hemostasis must be excellent. 3. Avoid taking too much internal sphincter, especially in women and patients over 60 years old. 4. Avoid the external sphincter. In patients with mucosal stenosis or a fissure and low MRAP (even clinically), the use of sutured anoplasty or Anal Fissure sliding island flap anoplasty as done for stenosis is advised by Farouk, Bartolo, and others.
Current Therapy in Colon and Rectal Surgery by Victor W. Fazio MBBS MS MD (Hon) FRACS FRACS (Hon) FACS FRCS (Ed) FASCRS OA, James M. Church MBChB MMedSci FRACS FACS, Conor P Delaney MCh PhD FRSCI ( Gen) FACS, Ravi P Kiran MD MBBS FRCS (Eng) FRCS (Glas) FACS