痔ろうの括約筋温存術におけるろう管染色併用法の有効性

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  • Feasibility of Ductal Staining Method Combined with Sphincter Preserving Operation for Anal Fistula

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From December 2001 to April 2003, patients with anal fistula were evaluated to identify the primary opening and the fistulous tracts by a newly developed staining method utilizing a screw. (1) 62% of total cases demonstrated the ejection of staining solution from the primary opening, enabling preoperative identification of the fistulas. (2) Facilitating the intraoperative macroscopic identification of the lesions by staining the tracts allowed the surgical incision to be minimized. In case of incising the tracts during preserving operations, the leakage of the staining solution provided information on misdirection that allowed us to reorient the direction of incision immediately. (3) Repeated and forceful injections of the staining solution, however, hindered the operation due to staining of the normal tissues, which made it extremely difficult to distinguish the lesion from normal tissues. (4) The recurrence rate between the sphincter preserving operation in combination with staining and conventional surgeries was similar : 8.0% and 7.7%, respectively. Nevertheless, this method is feasible especially for inexperienced surgeons or for the seton technique to identify the primary opening and fistulous tracts preoperatively.

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