Fissure of the Anus and Fistula in Ano

by Jr. Lewis H. Adler

The subsequent dressing of the case should be daily attended to by the surgeon himself. The parts should be kept perfectly clean, and the wound syringed with peroxide of hydrogen, carbolic acid solution, etc., after which a single piece of iodoform gauze laid between the cut surfaces of the wound will be all the dressing required.

In the after-treatment of these cases I have seen the healing process greatly retarded by excessive packing of the wound with the lint, or delayed by the undue use of the probe. Such interference is to be avoided.

If the granulations are sluggish, and the discharge is thin and serous, it will be well to apply some stimulating lotion, such as peroxide of hydrogen or a weak solution of copper sulphate (two grains to the ounce).

The surgeon should be on the watch during the healing process to avoid any burrowing or the formation of fresh sinuses. Should the discharge from the surface of the wound suddenly become excessive, it is evidence that a sinus has formed, and a careful search should be made for it. Sometimes it begins under the edges of the wound, at other times at the upper or lower ends of the cut surface, and occasionally it seems to branch off from the base of the main fistula.

Pain in or near the seat of the healing fistula is another symptom of burrowing, and when complained of the surgeon should carefully investigate its cause.

After an operation for fistula, the patient's bowels should be confined for three or four days, for which purpose opium is usually given. At the end of this time the bowels may be opened by the administration of a dose of castor-oil, and so soon as the patient feels a desire to go to stool an enema of warm water should be injected, which will tend to render the feces soft and fluid and hence make their passage easier. The patient should be kept in a recumbent posture until the fistula is healed; and until the bowels are moved the diet should be liquid—such as milk, beef-tea, and broths. The time required for a patient to recover after an operation for fistula in ano varies with the extent of the disease. In an average case it will be necessary to keep the patient in bed for two or three weeks, and confined to the house for a couple of weeks longer.

Fig. 44—Set of three Cautery Irons to fit one handle.

Fig. 45—Paquelin's Thermo-Cautery.