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Monday, April 26, 2010

Sit on a Seton.

A fistula in ano is a traumatic experience. Fistula literally means a connection between two epithelial lined surfaces. When it happens in the anal canal, it becomes a fistula in ano. Usually not painful, it presents with discharge from a tiny opening (usually) seen just around the anal opening with a connection somewhere inside. The low one's are relatively easy to treat but the high trans-sphincteric one's are a pain in the ass! Literally.


One of the ways to treat this is a Seton Stitch!  The procedure involves running a surgical-grade cord through the fistula tract so that the cord creates a loop that joins up outside the fistula. The seton loop will slowly cut through tissue inside the loop while scarring behind the loop, essentially "pulling out" the fistula without surgery.


Now to put forth a human perspective and what the patient feels. This man had a high fistula and to complicate things he also had Grade II Haemorrhoids (Piles). He was in pain due to both of the above conditions. He had already undergone a surgery for the fistula once somewhere in Bangkok, but it had recurred. I'm assuming that this was so because they must have not realised how high it actually was at the time of surgery. This is what he had to go through. Keep in mind this is what we Surgeon's do for a living!


 1.) Get examined with a proctoscope


2.) Have some methylene blue (ink) injected into the fistula




3.) Get probed with a probe 


 4.) Get Operated on


 5.) Take Sclerotherapy Injection into the Piles


 6.) Come for dressings and follow up  


 Only Steps 2-4 get anaesthesia. The rest are to be tolerated.


Can you imagine how painful it must be? 

The person we operated on today was done under sedation and local anaesthesia and he was still howling in pain. We couldn't do much more for him as he was unfit for general / spinal anaesthesia. Such is life.

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