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

It often happens that an infection that progresses inside is looking for a way out. This is especially true after surgery. Consider why this happens and how a fistula that appears after surgery is treated.

Fistula - what is it?

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

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

Types of fistulas

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

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

The fistula may be complete or incomplete. The full one has two holes and is treated faster, as it has a way out, while the incomplete one, having one hole, further develops the inflammatory process, the number of bacteria increases.

The fistula can be labial or tubular. The labioform is treated only with the help of surgery.

If we consider the formation process, then the granulating fistula is one that has not yet been fully formed, and the tubular fistula 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.
• The reaction of the body to a foreign body.

The fistula at the suture after the operation forms a seal of the suture 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 by its characteristic symptoms. They are:

If you have these symptoms, you need to urgently see a doctor, otherwise the infectious process may spread to the organs or cause blood poisoning.

Fistula Diagnosis

It is not difficult to diagnose a fistula after surgery, since it can be seen visually if it is external. The doctor, after listening to the patient, examining, pays attention primarily to:

• Quantity and quality of secretions.
• On 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 fistulous canal, probing and radiography are used.

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

It happens that the seam may begin to fester after a long time after the operation, so you need to find out the cause of this phenomenon.

If a fistula still appears after surgery, how to treat it?

Fistula treatment

For successful therapy, first of all, it is necessary:

As a rule, the wound begins to heal. If this does not happen, then surgical intervention is possible, in which excess granulations are removed, and cauterization of the sites is possible.

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

In severe cases, if several fistulas have formed, excision of the postoperative scar is shown completely. The infected suture 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 a few weeks. The wound will heal faster if you provide it with complete rest and proper care.

After rectal fistula surgery, the doctor usually prescribes a diet so that the wound heals faster. After such operations, it is necessary to prescribe painkillers and antibiotics. The wound heals within a month, any physical activity is excluded.

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

Folk methods of treatment

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

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

Fistula Prevention

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

• First of all, observe the rules of asepsis during the operation.
• All instruments and suture material must be sterile.
• It is necessary to carry out the treatment of the wound before sewing it up.
• Alloying of vessels should occur with a small capture of tissues.
• Prescribe antibiotics to prevent infections.
• It is necessary to treat all infectious diseases, preventing the development of fistulas.

The result of the operation, not associated with the treatment of a purulent wound, is the closure of the surgical field by suturing. If the tissues are infected, the surgeon creates an opportunity to remove pus and reduce the volume of infiltration. The suture material used in surgery may be of natural origin or be synthetic. Ligature sutures may dissolve spontaneously some time after surgery, or they will require the help of a doctor to remove them.

If a serous liquid of a dark cherry color, or purulent discharge, is released at the suture site, this is a sign of a developed inflammatory process and the formation of a ligature fistula. The appearance of these symptoms is a sign of ligature rejection and a reason for resuming treatment. The fistula that appeared after the operation cannot be considered as a normal phenomenon, urgent treatment is required under the guidance of a surgeon.

Reasons for the appearance of a ligature fistula:

Infection in the wound due to ignoring the requirements of antiseptics;

Allergic reaction to suture material.

There are factors that increase the likelihood of a postoperative fistula:

Patient's age;

Immune reactivity (in young people it is usually higher);

Accession of a chronic infection;

Hospital infection, typical for surgical and therapeutic hospitals;

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.

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

• labial. In this case, there is an fusion of fistulas and skin, as well as muscle tissue. Removal of fistulas is carried out using a surgical method.
• Complete. It is characterized by the presence of two exits, which makes it possible to most effectively combat the inflammatory process.
• tubular. It is a fully formed channel, from which there is a constant discharge 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 also aggravates.
• Granulating. With this type of fistula, granulation tissue is formed. With this pathological process, swelling and hyperemia are often observed.

About, what is a fistula after surgeryonly the doctor knows. After an appropriate diagnosis, a specialist will be able to determine the type of formation, which will positively affect the treatment process.

Reasons for the appearance

Postoperative fistulasmay 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 a surgical intervention, the human body may reject the thread, which is explained by intolerance to its components. Against this background, it appearspostoperative fistula. The development of neoplasms can be diagnosed in the presence of other provoking factors, which include:

• High immune reactivity of the organism;
• Elderly age;
• Chronic specific infection;
• hospital infection;
• Oncological diseases.

If vitamins and minerals enter the human body in insufficient quantities, this leads to the formation of fistulas.. Postoperative fistula, treatmentwhich is very long, appears in violation of the metabolism - diabetes, metabolic syndrome, obesity.

Before, how to treat a fistula after surgery, it is necessary to determine the cause of its occurrence. Therapy of pathology should be directed to its elimination.

Symptoms

Fistulas after surgerycharacterized by the presence of certain features. Initially, the appearance of a seal on the skin around the size is observed. There is pain on palpation. In some patients, the appearance of pronounced tubercles is diagnosed, which is used to secrete the infiltrate. Reddening of the skin may be observed at the site of infection of the scar.

The pathological process is often accompanied by a sharp increase in body temperature. This is due to the course of the inflammatory process in the human body. It is impossible to bring down the temperature to a normal value. Fistulas are accompanied by a purulent process. With untimely treatment of pathology, the size of the abscess increases significantly. In patients, there is a tightening of the fistulous opening for a certain period. This is followed by the development of inflammation.

Fistulas are characterized by the presence of certain signs. When 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

Fistula treatment 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 introduced into it.

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

Medical therapy

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

• Diclofenac;
• Nimesila;
• Dicloberla.

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

That, how long does it take for a fistula to heal after surgerydirectly depends on the characteristics of the rehabilitation period. Patients are recommended daily hygiene procedures in the area of ​​the operation. The patient is advised to disinfect the sutures daily with the help of 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 exclude heavy physical exertion. Prolonged work in a sitting position should be abandoned for three months.

How does it appear fistula after surgery, what is itonly the doctor knows. That is why, if neoplasms 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 institution can process 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-treatment is always fraught with inflammation and the introduction of an additional infection.

Again and again a tubercle appears - this is nothing more than a section of a thread (ligature). If you decide not to go to the doctor, but just wait until the suture comes out on its own, and the pus breaks out and the patient gets better, then you are at great risk. The fact is that the lack of medical intervention in this process is fraught with the development of complications (suppuration of neighboring areas, the 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 a surgical intervention to remove an inguinal hernia.
• Infection of the wound tissues occurred due to improper processing of the seam or non-compliance with hygiene and sanitation measures (this is a direct error of the doctor).

Precautions and Risk Factors

If the doctor has not established the cause, but simply excised the fistula from time to time, then this will not lead to any positive results. If the source of infection is not removed, is it possible to 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 processing of the suture.

In addition, the patient's age 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 originally 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 the excision of the fistula - this method of treatment is referred to as surgical (more radical). In 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 formation. By the way, the laser excision technique has been widely used recently. 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 reason for 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 to eliminate the infection, and not the fistula itself. If the focus of inflammation is removed, then the fistula will close on its own. In conservative treatment, antibacterial and anti-inflammatory drugs, antiseptics, as well as immunomodulating drugs and vitamin complexes are used (the importance of the immune system is discussed above).

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

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

Sincerely, Natalia.

If you know that all types of fistulas are divided into congenital, acquired, and artificially created, then the ligature fistula of the 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. And there is absolutely no difference which 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 postoperative scar

As a rule, the pathological process that has begun makes itself felt even before the patient is discharged home. Unfortunately, not everyone is attentive to their condition after the operation and certainly strives to be discharged from the hospital as quickly as possible. After all the worries about the upcoming surgical procedures, a slight redness in the suture area seems like such a trifle. However, only at the first signs of fistula development 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 action. 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, threads are removed in parallel, the endings of which appeared on the surface.

Medical 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.

Popular Vishnevsky ointments and synthomycin-based ointments are contraindicated due to their fatty base.

Surgical excision of the ligature fistula

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

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

A ligature fistula, which is treated both conservatively and surgically, is subjected to quartzization or ultrasound in a medical institution. Ultrasonic control allows you to make sure that all threads are removed without residue.

Treatment of ligature fistula at home

There are a lot of unconventional methods of treating various kinds of fistulas, but you should not rely on the ability to quickly cope with inflammation from the remnants of the ligature if they are not previously removed by dissecting the place of suppuration. If you miss the time, trying to fight with improvised means at home, then the process can be aggravated up to sepsis. When the focus 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.

Eg:

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