According to the latest statistical results, anorectal diseases have been increasing year by year. Some precise operations are also more perfect, and more and more people are involved in the operation. For this reason, we have the honor to enter the anorectal surgery department of Shanxi Huayi Anorectal Hospital, and experts will analyze the specific situation of incision and drainage of perianal subcutaneous abscess for everyone.

indications:

abscesses located in the superficial area are prone to fluctuation. Rectal submucosal abscess can also be easily found by anal digital examination or proctoscopy. However, if the pelvic and rectal abscess above levator ani does not penetrate into the superficial layer, it is impossible to find fluctuations. Only the skin on the affected hip is red, edema and induration, and the diagnosis can only be made by puncture and aspiration of pus. Once the abscess around rectum and anus is formed, it is not easy to be absorbed by itself, and even if it ruptures itself, the drainage is not smooth. Therefore, once the diagnosis is made, it should be cut and drained, and do not wait for the fluctuation to appear before cutting, so that more tissues will be necrotic after unnecessary infection.

preoperative preparation:

1. No special preparation is needed.

2. Patients under general anesthesia were fasted 6 hours before operation.

3. Skin preparation can be performed after anesthesia to reduce pain.

anesthesia: according to the location and scope of abscess, local anesthesia, saddle anesthesia (or spinal anesthesia) can be selected; Children or patients with excessive mental stress can use general anesthesia.

surgical procedures:

incision and drainage of perianal subcutaneous abscess: lithotomy position or lateral position. A radial incision was made at the perianal abscess, the length of which was equivalent to the size of the abscess cavity. After skin incision, hemostatic forceps was used for blunt separation, which entered the pus cavity and discharged pus. Then, put your finger into the abscess cavity to detect the size, and separate the fibers in the abscess cavity (if the subcutaneous group of external anal sphincter hinders drainage, it can be cut off without damaging its deep layer). After enlarging the incision as needed, cut off a little skin at the edge of the incision to make the drainage smooth. Finally, the necrotic tissue in the cavity was removed, and vaseline gauze was placed in the abscess cavity for drainage.

In order to avoid the formation of fistula in the future, after the abscess is cut, the inflamed recess (i.e. the internal orifice) should be found, and the tissue between it and the incision should be cut and drained smoothly. If the internal orifice is above the anorectal ring, it is not necessary to cut it, and it is advisable to operate by stages. Silk thread can pass through the internal orifice and then cut it after 2 ~ 3 weeks when the fistula is formed.

Precautions during operation:

1. Before the incision of deep abscess with no obvious fluctuation, it is necessary to puncture and aspirate pus again in order to know the position and depth of abscess cavity. If necessary, the puncture needle can be cut directly along the puncture site of the needle without being pulled out, and hemostatic forceps can be inserted into the abscess along the direction and depth of the needle.

2. You should not use violence when probing the size of the abscess cavity with your fingers and separating the fibrous septa in the cavity, so as to avoid tearing nerves and blood vessels as fibrous septa by mistake, causing bleeding, spreading infection and even complications such as sepsis.

postoperative treatment:

1. stay in bed and use antibiotics until the systemic symptoms subside.

2. It is advisable to eat a low-residue diet and take liquid paraffin or other laxatives to keep the stool unobstructed.

3. the drainage strip was gradually taken out from 2 to 3 days after operation; If the pus cavity is deep and large, and the pus is drained for a long time, it can be placed for a little longer. Usually, it can be completely removed about 1 week after operation. After the drainage is removed, take a sitz bath with 1∶5 potassium permanganate hot water, 2 ~ 3 times a day (including once after defecation).

4. When changing the dressing, pay attention to avoid bridge-shaped healing, and make sure that the granulation in the wound is gradually filled from the bottom to the outside to avoid forming fistula.