Postoperative fistula treatment. Removal of ligature suture endoscopic Ligature fistula postoperative scar treatment

It often happens that an infection that progresses inside seeks a way out. This especially happens after surgery. Let's look at why this happens and how the resulting fistula is treated after surgery.

Fistula - what is it?

A fistula is a canal that connects body cavities or hollow organs to each other or to the external environment. It is lined with epithelium, and through it pus comes out, or the canal is lined with granulation tissue. If this does not happen, then a purulent fistula forms.

Such a process may be the result of some inflammatory process in the body or a consequence of surgery.

Types of fistulas

Depending on where the fistula is located, they are divided into:

• Gastric fistula.
• Rectal.
• Rectovaginal fistula.
• Duodenal.
• Bronchial.

The fistula can be complete or incomplete. A complete one has two holes and is treated faster, since it has a way out; an incomplete one, having one hole, further develops the inflammatory process, the number of bacteria increases.

The fistula can be labiform or tubular. Lipoid can only be treated with surgery.

If we consider the process of formation, then a granulating fistula is one that is not yet fully formed, while a tubular one is already lined with epithelium and is fully formed.

What are the causes of a fistula after surgery?

There are several reasons for this phenomenon:

The last point is the most common reason why a fistula appears after surgery. There are also several explanations for this:

• Non-sterile suture material.
• The body's reaction to a foreign body.

A fistula at the suture after surgery forms a compaction of the suture thread itself, fibrous tissue and collagen fibers.

How to recognize the appearance of a fistula after surgery?

Since this is primarily an inflammatory process, it is not difficult to recognize a fistula after surgery based on its characteristic symptoms. They are like this:

If you experience such symptoms, you need to see a doctor immediately, otherwise the infectious process may spread to your organs or cause blood poisoning.

Diagnosis of fistula

Diagnosing a fistula after surgery is not difficult, since it can be seen visually if it is external. The doctor, after listening to the patient and examining him, pays attention first of all to:

• Quantity and quality of discharge.
• The size of the fistula, its color.
• If the fistula is interorgan, then pay attention to the work of neighboring organs, especially if there are changes.

In order to find out the length and direction of the fistula canal, probing and radiography are used.

It is also necessary to do a series of tests that will confirm the type of fistula. The gastric one will show the presence of hydrochloric acid, and the uric one will show the presence of uric acid salts.

It happens that the suture may begin to fester a long time after the operation, so you need to find out the reason for this phenomenon.

If a fistula does appear after surgery, how to treat it?

Treatment of fistulas

For successful therapy, it is first necessary to:

As a rule, the wound begins to heal. If this does not happen, then surgical intervention is possible, in which excess granulation is removed, and the areas may be cauterized.

The newest method is the treatment of fistula after surgery using ultrasound. This method is considered the most gentle, but it is not fast.

In severe cases, if several fistulas have formed, complete excision of the postoperative scar is indicated. The infected suture material is removed and a new suture is placed.

Postoperative intervention

If you still failed to cure the fistula and had to resort to surgical methods, then after the operation to remove the fistula, healing will take place within several weeks. The wound will heal faster if you provide it with complete rest and proper care.

After surgery for a rectal fistula, the doctor, as a rule, prescribes a diet so that the wound heals faster. After such operations, painkillers and antibiotics are required. The wound heals within a month, any physical activity is excluded.

The prognosis for treatment is usually good and the patient makes a full recovery.

Traditional methods of treatment

Of course, people always try to cure the disease at home. There are several recipes for treating fistulas with folk remedies. Here are some of them.

It is worth noting that if a fistula has formed after surgery, then treatment should be carried out under the supervision of doctors, and folk remedies are an addition to the main course.

Prevention of fistulas

In order to prevent fistulas from appearing after surgery, it is necessary:

• First of all, observe the rules of asepsis during surgery.
• All instruments and suture material must be sterile.
• It is necessary to treat the wound before suturing it.
• Vessel doping should occur with little tissue involvement.
• Prescribe antibacterial drugs to prevent infections.
• It is necessary to treat all infectious diseases, preventing the development of fistulas.

A fistula is a pathological channel that connects a hollow organ and the external environment or two hollow organs. Most often appearsfistula after surgery. Treatment of this formation is quite long and painful. That is why the patient must strictly adhere to the doctor’s instructions.

A fistula is a hollow neoplasm that in appearance resembles a deep wound. In accordance with the characteristics of the development of neoplasms, they can be:

• Lip-shaped. In this case, fusion of fistulas and skin, as well as muscle tissue, is observed. Removal of fistulas is carried out using a surgical method.
• Full. It is characterized by the presence of two outputs, which provides the opportunity to combat the inflammatory process as effectively as possible.
• Tubular. It is a fully formed canal from which there is a constant release of feces, pus and mucus.
• Incomplete. The neoplasm is characterized by one exit, the location of which is the abdominal cavity. With this type of fistula, pathogenic microflora multiplies and inflammation worsens.
• Granulating. With this type of fistula, granulation tissue is formed. With this pathological process, swelling and hyperemia are quite often observed.

About what is a fistula after surgeryonly the doctor knows. After carrying out the appropriate diagnostics, the specialist will be able to determine the type of formation, which will have a positive effect on the treatment process.

Reasons for appearance

Postoperative fistulascan develop for a variety of reasons. Most often, pathology is observed against the background of an infectious process that enters the human body through sutures and wounds. After surgery, the human body can reject the thread, which is explained by intolerance to its components. Against this background appearspostoperative fistula. The development of neoplasms can be diagnosed in the presence of other provoking factors, which include:

• High immune reactivity of the body;
• Old age;
• Chronic specific infection;
• Hospital infection;
• Oncological diseases.

If the human body receives vitamins and minerals in insufficient quantities, this leads to the formation of fistulas. Postoperative fistula, treatmentwhich is very long-lasting, appears when there is a metabolic disorder - diabetes, metabolic syndrome, obesity.

Before how to treat a fistula after surgery, it is necessary to determine the cause of its occurrence. Therapy for pathology should be aimed at eliminating it.

Symptoms

Fistulas after surgerycharacterized by the presence of certain characteristics. Initially, a thickening appears on the skin around the size. When it is palpated, pain is observed. Some patients are diagnosed with the appearance of pronounced tubercles, which release the infiltrate. At the site of infection of the scar, redness of the skin may be observed.

The pathological process is often accompanied by a sharp increase in body temperature. This is explained by the inflammatory process in the human body. It is impossible to bring the temperature down to normal. Fistulas are accompanied by a purulent process. If the pathology is not treated in a timely manner, the size of the abscess increases significantly. Patients experience tightening of the fistula opening for a certain period. After this, inflammation develops.

Fistulas are characterized by the presence of certain signs. If they appear, patients are advised to immediately consult a doctor. Timely treatment of the disease will eliminate the possibility of side effects.

Features of therapy

Treatment of fistula after surgeryin most cases requires surgical intervention. Initially, the surgical field is treated with special antiseptic solutions, which will eliminate the possibility of infection. Surgery requires the use of local therapy. In order for the surgeon to find the course of the fistula as quickly as possible, a dye solution is injected into it.

The surgeon uses a scalpel to remove the fistula. All other actions of specialists are aimed at stopping bleeding. After this, it is recommended to wash the wound with an antiseptic solution. Postoperative sutures are applied to the wound. In this case, it is recommended to use active drainage.

Drug therapy

Treatment of postoperative fistulas requires the use of not only surgery, but also appropriate medications. In most cases, patients are prescribed antibiotics and anti-inflammatory drugs:

• Diclofenac;
• Nimesila;
• Dicloberla.

In order to speed up the wound healing process, the use of Troxevasin or Methyluracil ointment is recommended. It is also recommended to use drugs that are of plant origin - aloe, sea buckthorn oil, etc.

That, How long does it take for a fistula to heal after surgery?, directly depends on the characteristics of the rehabilitation period. Patients are recommended to carry out daily hygiene procedures in the area of ​​the operation. The patient is recommended to disinfect the sutures daily using special preparations. The patient's diet should be rich in fiber, which will eliminate the possibility of constipation. In the postoperative period, it is recommended to avoid heavy physical activity. Long-term work in a sedentary position must be avoided for three months.

How it appears fistula after surgery, what is it?only the doctor knows. That is why, if tumors occur, it is necessary to seek help from a doctor who will determine the type of formation and prescribe rational therapy.

Hello, Olga Vladimirovna.

Only a qualified surgeon in a medical facility can treat and treat (if necessary) a ligature fistula. Despite the fact that this is not the first time you have encountered this problem, and, as it may seem to you, you already know perfectly well what you are dealing with, it is highly not recommended to carry out any independent manipulations with the fistula. Self-treatment of affected tissues and any other self-medication is always fraught with inflammation and additional infection.

A tubercle that appears again and again is nothing more than a section of thread (ligature). If you decide not to see a doctor, but simply wait until the suture material comes out on its own, the pus breaks out and the patient gets better, then you are taking a very big risk. The fact is that the lack of medical intervention in this process is fraught with the development of complications (suppuration of neighboring areas, development of phlegmon, etc.).

The appearance of ligature fistulas occurs for the following reasons:

• The suture material (ligature) was initially infected.
• The infection was introduced during surgery to remove an inguinal hernia.
• Infection of the wound tissue occurred due to improper treatment of the suture or failure to comply with hygiene and sanitation measures (this is a direct mistake by the doctor).

Precautions and Risk Factors

If the doctor has not established the cause, but simply excises the fistula over and over again, this will not lead to any positive results. If the source of infection is not removed, can we hope for a normal process of tissue regeneration? Naturally not! It is possible that the doctor does not sufficiently comply with the rules of sanitation and subsequent treatment of the suture.

In addition, the age of the patient can also play an important role, because a 70-year-old man’s immunity is already weakened and cannot fully perform the functions that were initially assigned to him. But it is the state of the immune system that largely determines the success of the healing process of postoperative sutures and the absence of the risk of complications.

Treatment and prevention of ligature fistulas

You mention excision of the fistula - this method of treatment is classified as surgical (more radical). During surgical treatment, it is extremely important to remove the infected ligature from the fistula, which does not resolve. The presence of suture material in the wound can cause subsequent fistula formations. By the way, laser excision has recently been widely used. This device is more accurate and reliable, because it eliminates the human factor, and for the patient himself, the procedure for removing the ligature with a laser is more gentle.

However, if the cause of the regular formation of a fistula is an infection (I remind you that based on your description, the doctor has not established the cause), then conservative treatment is used, aimed at eliminating the infection, and not the fistula itself. If the source of inflammation is removed, the fistula will close on its own. Conservative treatment uses antibacterial and anti-inflammatory drugs, antiseptics, as well as immunomodulators and vitamin complexes (the importance of the immune system is discussed above).

Effective preventive postoperative measures include strict adherence to the rules of antiseptic wound treatment. If we talk about the measures that should have been taken by the surgeon before the operation, it is important to talk about:

• careful preparation of the wound before suturing;
• checking the suture material for sterility;
• the use of high-tech suture materials and the refusal to use non-absorbable threads.

Best regards, Natalya.

If you know that all types of fistulas are divided into congenital, acquired, and artificially created, then a ligature fistula of a postoperative scar will belong to the latter category. Therefore, it can occur anywhere if there has been a surgical intervention, after which inflammation has developed from the suture surgical material itself - the ligature. Moreover, it makes absolutely no difference what kind of thread was used (synthetic, natural, absorbable or not). Sometimes the cause of a fistula is the negligence of medical personnel, but it happens that the body itself rejects foreign material.

Conservative treatment of ligature fistula of a postoperative scar

As a rule, the onset of the pathological process makes itself felt even before the patient is discharged home. Unfortunately, not everyone is attentive to their condition after surgery and certainly strives to be discharged from the hospital as quickly as possible. After all the worries about the upcoming surgical procedures, a little redness in the suture area seems like such a trifle. However, only at the first signs of development of a fistula and the initial stage of suppuration, its conservative treatment is possible.

An experienced surgeon himself will determine that the healing process of the suture has deviations and will take timely measures. Firstly, the site of inflammation is carefully examined, dead tissue is removed so that the wound heals faster. This is done in several stages with constant treatment of the seam with an antiseptic solution. Secondly, the threads whose ends appear on the surface are simultaneously removed.

Drug treatment is prescribed:

• antibiotics (Ceftriaxone, Norfloxacin, Levofloxacin);
• local antiseptics in the form of powders and water-soluble ointments (Levomikol, Trimistin);
• enzymes that dissolve dead cells.

The popular Vishnevsky and syntomycin-based ointments are contraindicated due to their oily base.

Surgical excision of ligature fistula

It is much worse if the fistula is on internal organs. Or outside, but the inflammation has gone too far. In this case, there are two options for radical measures:

• removal of suture material without dissecting the fistula through its hollow canal;
• complete excision of the fistula in order to remove the ligature and wash the wound from suppuration.

Ligature fistula, which is treated both conservatively and surgically, is subjected to quartz treatment or ultrasound in a medical institution. Ultrasonic control makes sure that all threads are removed without leaving any residue.

Treatment of ligature fistula at home

There are a lot of non-traditional methods for treating various types of fistulas, but you should not rely on quickly coping with inflammation from the remains of the ligature if they are not first removed by dissecting the site of suppuration. If you waste time trying to fight with improvised means at home, the process can worsen, even to the point of sepsis. When the source of inflammation is correctly removed in the hospital, the doctor himself will probably give advice on what simple procedures can be done at home to speed up the closure of the wound.

For example:

1. A saline bandage is applied to the ligature fistula as an antiseptic to prevent re-inflammation, which helps even if it was not possible to remove all the threads during dissection. The concentration of the saline solution is made at the rate of 1 tsp per glass of hot boiled water.
2. You can wash the fistula site with fairly hot salt water, make lotions or.
3. Treatment of ligature fistula with Dimexide is also quite common at home. This is a cheap universal concentrate from which you can prepare a 50%-90% aqueous solution for lotions. Demixid has the ability to draw out all impurities from a purulent wound.