Dat

• mei 2011

Ind

• peri-anaal abces

Netten

• Rectum net

• alternatief: Klein basis net + Fistel sonde set (DC)

Pos

• Steensnedeligging

• Skischoenen

Thema

• geen

App

• Diathermie

• Zuigerij

Afd

• Lithotomielaken = Gyn set

Disp

• deppers

• zuigslang + -buis

• evt diathermiemesje

• mesje 10

• 10x20

• evt. golfdrain of handschoendrain

• evt. Vicryl 3-0 SH

• instellagel

• evt. kweekstokje, -glaasje, - urinecontainer, spuitje

• evt. 'comfort drain' (= seton bij anale fistel), kast 64

• Exupad

Operatieverloop

• • patient in steensnedeligging positioneren

  • desinfectie (Chloorhex in water)

  • afdekken met lithotomielaken

  • evt. spreider inzetten (instellagel)

  • incisie (mesje 10)

  • evt. diathermie, zuig

  • abces opzoeken, pus laten draineren

  • evt. kweek afnemen

  • evt. drain achterlaten (golfdrain of handschoendrain)

  • drain vasthechten (Vicryl 3-0 SH)

  • Exupad op wond

Cutting seton — if the fistula is in a high position and it passes through a significant portion of the sphincter muscle, a cutting seton (from the Latin seta, "bristle") may be used. This involves inserting a thin tube through the fistula tract and tying the ends together outside of the body. The seton is tightened over time, gradually cutting through the sphincter muscle and healing as it goes. This option minimizes scarring but can cause incontinence in a small number of cases, mainly of flatus. Once the fistula tract is in a low enough position it may be laid open to speed up the process, or the seton can remain in place until the fistula is completely cured.