DATE OF OPERATION: MM/DD/YYYY
PREOPERATIVE DIAGNOSIS: Fistula-in-ano.
POSTOPERATIVE DIAGNOSIS: Fistula-in-ano as well as abscess.
OPERATION PERFORMED:
1. Incision and drainage of abscess.
2. Seton fistulotomy x2.
SURGEON: John Doe, MD
ANESTHESIA: General.
FINDINGS AND DESCRIPTION OF PROCEDURE: After informed consent was obtained, the patient was taken to the operating room and placed in the supine position. After adequate induction of general anesthesia, he was placed in the lithotomy position. The perineum was prepped and draped with Betadine.
A perianal block was performed with 30 mL of 0.25% Marcaine with epinephrine. The perianal skin was infected. There was multiple scarring in the areas of induration. On digital rectal exam, the canal was stenotic entirely with very noncompliant tissue. In fact, we were only able to get the smallest Hill-Ferguson retractor within. On examination, there were obvious external openings in the left posterolateral region. One of these was injected with peroxide solution, and upon doing this, multiple fistula tracts all along the left side, about four to five of them, became obvious. On internal inspection, there was clearly an internal opening in the posterior midline.
A probe was inserted through one of these, through the most posterior opening and brought through the internal opening. This was exchanged with a silk suture, which was then exchanged with a metal loop and secured with two sutures of #0 silk. The other fistula tracts were unroofed. The fistula tract was opened up and the granulation tissue curetted out. Upon doing this, we opened into a very large cavity, which was likely a deep postanal space abscess. Also, it extended all along the ischiorectal fossa and lateral to the rectum up for several centimeters. There was copious granulation tissue within this area. It was all curetted out. A second vessel loop was placed at horseshoe extension with fistula just anterior to the other one.
The abscess cavity was then packed with several feet of 1/2-inch Nu Gauze. The patient tolerated the procedure well without any complication. Postoperatively, the patient was extubated and transferred to the recovery in stable condition.
