Surgical policy for treatment of anal diseases (The basic and practical consideration)

概要

論文の詳細を見る
In the surgical treatment for anal diseases, it is thought important to perform the procedures as protectively as possible in order to preserve the postoperative anal function. In addition, from the standpoint of particular significance of anal wound healing, well-formed drainage wounds are always necessitated. Furthermore, careful attention should be paid for possible colorectal pathology hidden behind the anal diseases.<BR>For the hemorrhoidal diseases, an excessive removal of anal mucocutaneous segments may result in postoperative anal stenosis. It is recommended to form each skin bridge at least 1.0cm in width, and it would not be troublesome if the epithelium of at least a half of the entire anal circumference is left behind. In order to prevent recurrence of hemorrhoids, it is impo-rtant to ligate the branches of the superior rectal artery at a sufficiently high level. The au-thor usually makes a double ligation of them at 3.0cm proximal to the dentate line.<BR>For intersphincteric fistulas of posterior and simple type, a fistulotomy would be usually sufficient without significant complications. For those of anterior and lateral type, or of multiple type, however, sphincter-preserving procedures should be employed ; the author has obtained desirable results following the new procedure of Sumikoshi-Iwadare.