rectovaginal fistula repair

The cause of rectal vaginal fistula is similar to vaginal vagina, common in birth trauma, surgical trauma and radiation trauma. According to the distance between the pupil and the anus or vaginal opening, it is divided into low and high pupils. Both showed that there was stool overflow from the vagina, and in severe cases, stool could not be controlled. Treatment of diseases: rectal vaginal fistula Indication Rectal vaginal fistula. Preoperative preparation 1. Enteral preparation for 3 days of fluid diet, while oral administration of intestinal antibiotics. Clean the enema before and on the morning of the operation. 2. 3 days before the vulva and vaginal preparation, use a 1:5000 potassium permanganate basin, disinfect the cotton ball to wipe the vulva and vagina. Surgical procedure (1) Low rectal vaginal hernia repair is suitable for pupils with lower vulva and anal position. Such pupils are often large, sometimes combined with anal sphincter dysfunction, the perineal and anal sphincters below the pupil should be cut from the median and repaired. 1. Position and disinfection: take the stone. Routine disinfection of the vulva and vagina. 2. Incision: A similar incision is made along the lateral edge of the pupillary scar. For the large pupil, an incision from the lower edge of the pupil to the center of the anus is required. 3. Cut the anus: cut along the midline, from the anal sphincter and perineum, up to the edge of the pupil. 4. Separate the vaginal and rectal wall: When the fistula has obvious scar, remove it first, but not too much, so as to avoid vaginal and rectal stenosis after repair. The mucosa of the vagina and rectum is separated sharply and/or bluntly along the pupil. 5. Stitching the rectal wall: 1 cm from the edge of the rectal mucosa, two layers of varus, discontinuity, suture the rectal wall. 6. Stitching the anal sphincter: Clamp the anal sphincter's broken end in the depression on both sides of the rectum, draw it toward the midline, and suture with "8". 7. suture the rectal fascia: intermittent suture of the rectal fascia. 8. Check the anal sphincter and rectum: Insert the finger into the anus. When the patient contractes the anus, there may be a sense of contraction, suggesting that the anal sphincter has been sutured intact, and the rectal suture can also be examined. 9. Stitching the levator ani muscle: the anterior levator ani muscle is sutured with 2 to 3 needles. 10. Stitching the vaginal wall: the vaginal wall is sutured intermittently, and the cervix marks are opposite. 11. Suture the perineal skin. 12. Check the rectum and vagina: the vagina should be able to accommodate two fingers, the anus is slightly loose by a finger, and has a sphincter contraction. Too tight anus can cause difficulty in defecation and should be noted during surgery. 13. After the operation, the vagina was filled with iodoform gauze and taken out in 72 hours. (B) high rectal vaginal hernia repair repair method is basically the same as vaginal hernia repair. Between the vaginal wall and the rectal wall, the tissue surrounding the pupil is separated to separate the posterior wall of the vagina from the wall of the rectum. The separation range is 1 to 1.5 cm from the pupil, and the rectal wall is sutured in two layers. Stitch the vaginal mucosa The rectal suture was examined after surgery. Iodine gauze was inserted into the vagina. If the pupil is only located in the vaginal vault and the uterus has been removed, similar to the repair of the high vaginal vagina, high vaginal closure is feasible. For the larger pupil, in order to ensure the successful repair, about 2 to 3 weeks before the repair, a temporary sigmoid ligation should be performed to make the feces diverted. The colon will be retreated 6-8 weeks after the hernia repair. The stoma is closed. complication Vaginitis, intestinal obstruction. Postoperative diet 1. Give high protein, high vitamin and cellulose-rich digestible diet. 2, do not eat spicy spicy food. 3, avoid drinking alcohol.

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