Hellow guys, Welcome to my website, and you are watching USA Man | Type 4 Intersphincteric Anal Fistula with Supralevator Abscess cured by DLPL Laser surgery. and this vIdeo is uploaded by Dr Ashwin Porwal's Healing Hands Clinic at 2023-04-01T03:31:58-07:00. We are pramote this video only for entertainment and educational perpose only. So, I hop you like our website.
| Name | USA Man | Type 4 Intersphincteric Anal Fistula with Supralevator Abscess cured by DLPL Laser surgery |
| Video Uploader | Video From Dr Ashwin Porwal's Healing Hands Clinic |
| Upload Date | This Video Uploaded At 01-04-2023 10:31:58 |
| Video Discription | DLPL Notes DLPL Distal Laser proximal Ligation Novel technique innovated by Dr Ashwin Porwal for complex / recurrent fistula Step 1 : Identify the internal opening by per Rectal examination. Palpate the tract and identify external opening. Some intersphincteric fistulas may not have external opening. They are usually associated with deep anal abscess or horse shoe abscess or infralevator or supralevator abscess. Good PR and Bimanual palpation to identify the Intersphincteric abscess. Look for Rectal abscess to rule out levator / supra levator abscess. Step 2 : Approach the internal opening by making a superficial incision over anal skin. Insert the bare tip laser fibre in the internal opening ( upto 1cm Or less ) and deliver around 50-70 Joules of energy. In cases of Intersphincteric fistula without external opening , Identify the Intersphincteric abscess ... Debride the Intersphincteric abscess wall by use of 1470nm Bare tip fibre. Deliver around 100-150 Joules. Usually they are associated with supralevator / Infralevator / Horse shoe abscess. Keep them wide open for drainage . Extend the anal skin incision over the external sphincter muscles to get access during follow up for cleaning the cavity. This will prevent collection within the Intersphincteric space. Keep the incision open for drainage. Step 3 : Probe the fistula tract through external opening Or flush it with normal saline to identify the exact location of fistula opening Within the sphincter muscle Step 4 : Thorough scooping of the fistula tract to achieve good debridement. Flush it with saline. Step 5 : Laser debridement of fistula tract by use of Radial Fibre with 1470nm Diode laser at power of 10W. Deliver 100 Joules of energy in continuous mode starting from Internal opening or the sphincter muscles and moving out towards external opening. Do not force the laser fibre or probe beyond the sphincter muscles in an attempt to reach the internal opening as most of the complex fistulas will take a curved course after hitting the internal sphincter. That is why laser debridement from internal opening upto 1cm is recommended for such complex fistulas. Step 6 : Widen the external opening for good drainage. Step 7 : Single stitch TransAnal Closure of internal opening within the sphincter muscles with Uroneedle in cases where the internal opening is wide. Suturing is not required if the Internal Opening is narrow like a hairpin or in cases of Intersphincteric fistulas without external opening. Step 8 : Achieve hemostasis. Keep Both the wounds open for drainage. Follow UP First follow up on 4th day. Palpate the tract to drain the serous collection within the tract through the external opening ( EO ) Flush the exposed Internal opening with betadine. Bimanual palpation over the anus to identify collection especially in Intersphincteric fistula cases. Second Follow up : 2wks. Same steps like first follow up. Look for any collection in the Intersphincteric space by bimanual palpation. Rule out collection within the fistula tract. In case of collection ... drain it under local anaesthesia on Opd basis 1month follow up : Make sure the external opening wound is not closed. Keep it open to prevent collection. External opening should not heal before the internal opening heals. Debride the hypergranulation at the level of IO In Intersphincteric fistula with external opening. 6wks : The wound will usually heal by 6-8 wks 3months follow up : To ensure the healing is smooth and fistula has healed. DLPL is a minimally invasive sphincter saving surgery for complex fistula. It addresses the Intersphincteric space which is the root cause of complex fistula. It is based on two principals 1) Debridement : This is achieved in a minimally invasive way by use of laser. Use of laser makes the debridement more effective and takes care of the fibrosis associated complex fistulas. The debridement is thorough and deep with use of laser. Laser fibre can be easily negotiated within the Intersphincteric space and supralevator space. Inefficient debridement is one of the cause of recurrence in fistula. 2) Drainage : Efficient drainage from the fistula in the first two to three weeks is key to success in curing fistula after surgery. Widening of the external opening serves that purpose. Similarly superficial incision over the internal opening helps in proper drainage in initial 3 weeks after surgery. This is achieved by timely follow up planned at 5 days , 2 wks , 4wks and 6wks. That’s the reason why DLPL is associated with negligible recurrence rate. There is no need of daily dressing with DLPL and this patient can resume work in 3-5 days. There is no risk of Incontinence as sphincter muscles are not incised. Thus DLPL serves the purpose in bridge the gap in surgical management of complex fistula. |
| Category | Education |
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