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Файл:Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_1420_Библиотеки_им_академика_М_И_Перельмана.pdf
8 Surgical Treatment ofAnal Fistula
117
Fig. 8.5 Hanley’s technique. When the ends of the
branch pipes extending to both sides are thin, only the
internal mouth and the original abscess are removed, the
Fig. 8.6 Goligher’s procedure for ischiorectal fossa surgery. When the branches extending to both sides are thick,
only the internal mouth and the primary abscess are
are scratched clean, and wound drainage is conducted (Figs.8.6 and 8.7).
8.2.2 Anal Fistula Thread-Drawing
8.2.2.1 The Origins
Thread-Drawing WasFirst Recorded
intheMing Dynasty
The thread-hanging therapy in China was rst
recorded in Gujin Yitong written by Xu Chunfu,
a doctor in the Ming dynasty (1556 AD). The
book records: “Chunfu’s method of treating anal
wound is open and drained, and the ends of the branch
pipes on both sides remain
removed and the wound is open for drainage, and both
sides open for drainage
stula, ..... The far-reaching inuence must be the
thread-hanging therapy in “Yonglei Qian Fang,”
which can cure anal stula thoroughly.”
Therefore, the term “seton” was rst put forward
in the “Yonglei Qian Fang,” which is probably
the earliest record of thread-drawing in China.
Previously, in almost all works of traditional
Chinese medicine on anorectal diseases, it was
believed that “Yonglei Qian Fang” had been lost.
In fact, the book was not lost. At present, there
are two editions printed by the People’s Health
Publishing House and Medical Science and
Technology Publishing House, respectively. The
author checked the two versions of the book and
118
Hanley’s procedure Ui’s modified procedure Goligher’s procedure
Fig. 8.7 Comparison of Hanley’s procedure, Goligher’s procedure, and UI’s modied procedure
R. Shi and L. Zheng
found that the contents are basically the same.
However, the author could not nd the relevant
contents on the hanging line of anal stula in
“Yonglei Qian Fang” in these two editions, only
the content of ligating of hemorrhoids by boiling
the thread of Daphne genkwa root. Are the relevant pages or contents of the original book lost?
This needs further research.
Anal Fistula Thread-Drawing Therapy
intheMing Dynasty WasQuite Mature
In “Gujin Yitong,” the origin of thread-hanging
therapy, the method of making the medicine line,
the method of thread-hanging operation, the
indication of thread-hanging therapy, the change
of condition after thread hanging, the course of
treatment, the curative effect, and even the
mechanism of treatment were introduced comprehensively. The method of making the medicine line introduced in this book is “[to treat]
external hemorrhoids and anal stula, scrotal
abscess, acute pyogenic infection of perineum,
gluteal abscess. Roots of Daphne genkwa (no
matter how much, pound the juice in the Tong
Tiao, slow re boil into an ointment, put raw silk
thread into the ointment and boil for a long time
until the ointment becomes thicker. Let the line
dry in shade, and the ointment is retained for
later use).” Indications are as follows: “when the
anal stula has more branches and a longer
course of disease, although the San Pin Ding Zi
is used to eliminate necrotic tissues and promote
granulation, it is only for the treatment of low
anal stula. For high anal stula, hanging thread
therapy in “Yonglei Qian Fang” can almost
always cure it”. The hanging operation method
is: “regardless of the number of sores, use grass
to explore a hole, lead the line out of the intestinal, drop the plumb, and let hanging to take
quick effect.” The expected course of treatment
was: “10 days or half a month, and no more than
20 days.” Curative effect is: “The thread passes
through the anus, if the hammer falls off, it cures
a hundred times without perforating the sore, the
goose tube disappears, and the skin returns to
normal after 7 days.” The treatment mechanism
is as follows: “the medicine thread dips, the
enteric muscle grows with time, the spot is
replenished. Water ows down the line, like the
dike, and the water has returned to being submersible. After all ows away with the ood, is
there still a ood?”
8 Surgical Treatment ofAnal Fistula
119
At the same time, the book details the clinical
application of how to hang the line, how to tie the
knot after hanging the line, what to do when
encountering an area difcult to pierce through,
etc. Details include: “a stula with three carbuncles, regardless of how many dozen sores, the
choice to cure the anus is with the Irisensata
Thunb. If there is a hole through the bowel, rst
bend the silver bar, dig into the valley road and
hook out the straw. Thread six or seven inches of
one end into a exible buckle. Do not pull the
head of the grass lead through the large intestine,
the thread untangling head is one inch long inside
the buckle, tie three, four or ve cents onto the
end to hang down, when sitting and sleeping keep
clothes from sticking, quick results are desirable.
Wash the line early every day for about ve minutes long, leave one inch, the thread lasts 7 days
and is more than three inches below the line. If the
source is blocked, with no perforation and no
abscess, the goose tube is changed, rst remove it
all. The sore is close to the anus for 10 days, then
the semilunar line comes down through the anus,
and it will drop after 20 days. If 7 days after the
fall, the paracubic sores are still wet, the line must
be hung again. If it cannot be pierced, dip the needle into the paper instead of sticking it until it
hurts. That is, at the zigzag point, thrice pass the
threading. When the line falls, use Shengji powder.” The details of the relevant content are so
clear, it would have been difcult to achieve this
amount of detail without skilled and frequent
practice. Therefore, it must have been put in practice many times, indicating that the therapy was
already quite mature in clinical use at the time.
“Gu Jin Yi Tong”’s record of string therapy
was so detailed mainly because the author himself was a patient of anal stula and a beneciary
of string therapy. It is written in the book: “to
have suffered from this disease for 17 years, I
have read a lot of books, learned the ancient
ways, received useless treatments, exposed
myself to poison and worried about intaking food
and sleep. After meeting Li Chunshan of Jiang
You, he cooked the string of common turnip only
and hung the large intestine. In more than 70 days
only he achieved full success.” From this, we can
know that Xu Chunfu’s thread-hanging therapy
was learned from Li Chunshan, and he had personal experience of its application.
The Contents ofThread-Drawing Have
Been Enriched Since Ancient Times
withModern Medicine, But There Has
Been No Breakthrough
“Surgery Dacheng”: “if you use thread hanging,
if there are many holes, treat one hole rst, and
then every few days treat another hole.” It detailed
the thread-hanging treatment method of multiple
external openings or multiple stulas.
“Yi Men Bu Yao” pointed out that “if the
patient is a virtual person, hanging the line
method cannot be used and it is easy for the task
to turn into an incurable labor.” “Virtual people”
are those that were found to be contraindications
to hanging the line method. This is still of great
signicance. Currently, for patients with abnormal wound healing of Crohn’s anal stula and
tuberculous anal stula, it is forbidden in principle to use tight thread treatment.
“Surgery Illustrated” contained the atlas of
“anal tube probes,” “anal needles,” “sickle
knives,” and so on, enabling later generations to
have an intuitive understanding of the instruments
used by doctors at the time for anorectal surgery.
The Real Reform ofThread Therapy Came
After theFounding ofNew China
Since the founding of the People’s Republic of
China, thread-linked therapy has been continuously reformed and innovated by specialists in
anorectal surgery in China, and its treatment
pool has expanded from single anal stula to
perianal abscess, rectal stenosis, constipation,
anal ssure, and other diseases, and its treatment
mechanism has been further recognized. In its
usage, continuous improvement has been made,
from the initial drug line gravity hanging through
the rubber band hanging line, to low incision
high hanging line, virtual hanging line, virtual
and real hanging line together with a series of
changes. It has now become one of the most
common traditional methods in the clinical
application of anorectal treatment.
120
8.2.2.2 The Evolution ofThread
Hanging
Since it was recorded in the Ming dynasty,
thread-hanging therapy has been applied in clinics and recorded in the medical books of past
dynasties. However, the thread-hanging therapy
now in use is very different from the one Xu
Chunfu talked about. In my opinion, there have
been at least six major changes in the current
thread-hanging therapy compared with Xu’s
original method.
The Change fromGravity Hanging Line
toDaily Tightening Line
Because there is no textual research on threadhanging therapy in “Yonglei Qian Fang” at present, it can only be analyzed by comparing the
thread-hanging therapy in “Gu Jin Yi Tong.” The
“YiMen BuYao” recorded, “use a thin copper
needle to create the medicine line, the right hand
holds the needle to be inserted into the stula, the
left hand holds the thick spicule to be inserted
into the anus, hook out the needle and medicine
line, tie a knot, gradually tighten, add buttons to
the end of the medicine line to pull it down, the
pipe is open for 7 days, mix medicine into the
raw muscle, the wound should be closed in a
month.” This shows that its method is a daily
tight hanging line therapy and is different from
“Gu Jin Yi Tong”’s gravity hanging line method,
so it can be regarded as the earliest alteration to
the hanging line therapy.
The Change fromUsing aDrug Wire
toaRubber Band
The traditional thread-hanging therapy (Fig.8.8)
uses medicinal thread, which is a raw silk thread
boiled and soaked with the root of Daphne. In the
process of use or in the drug line, it is sprinkled
with Jiuyi Dan and other drugs. The thread itself
contains the drug or can have characteristics of
the drug.
When hanging the drug wire, insert the thread
into the stula through the outer opening and tie
a movable knot to make a ring after piercing the
inner opening. Because the thread itself does not
have the force of contraction, copper or iron and
other weights should be hung on the thread ring
R. Shi and L. Zheng
Fig. 8.8 Anal stula’s traditional medicine thread hanging therapy
after hanging to slowly open the stula. As the
stula is gradually opened from the inside out,
the wound grows from the inside out, with a high
success rate, good protection of the anal function,
and satisfactory appearance after healing. These
are the advantages of traditional thread-hanging
therapy. Traditional suture therapy often takes
more than 1 or a half months to open all stulas.
At the same time, the drug line needs to be tightened several times after hanging. After hanging
heavy weights on the drug line, the pain is greater
and brings inconvenience to patients’ lives and
walking. These are the disadvantages of traditional thread-hanging therapy.
For this reason, since the 1960s, rubber bands
have been gradually used instead of medical
threads. Because the rubber band is low in cost,
easy to obtain, and has its own contraction force,
after hanging the string, by tightening the rubber
band and using the contraction force of the rubber band itself, the stula can be slowly opened
without hanging an iron block on the line, and it
is cut gradually. The effect is continuous, controllable, and rapid, which greatly shortens the time
for the thread to cut off the stula. It also simplies the surgical procedures and post-operative
care and facilitates patient activities after surgery.
Such hanging lines are also called elastic hanging
lines. However, the author believes that the use of
rubber bands to replace medical threads is not
perfect. The most obvious shortcoming is that the
8 Surgical Treatment ofAnal Fistula
cutting effect of the rubber band thread-hanging
therapy is not from the upward or downward, or
from deep to shallow, but from the surroundings
to the center. After the stula and the sphincter
are cut, the distance between the muscle ends is
large, and the protection of the anal function is
not as good as the traditional medicine threadhanging treatment.
The use of ordinary surgical silk thread to
replace drug thread hanging is another reform of
the hanging line treatment method. However, at
present, such thread hanging is hardly used for
real thread hanging (tight thread hanging). It is
mainly used for thread hanging and drainage. A
total of 10–20 silk threads are used to hang the
stula and are knotted into a ring to prevent slippage. This kind of loose hanging thread has none
of the traditional effects of the medical thread
itself. Although Jiuyidan and other medicines can
be attached to the wet silk thread when changing
dressing, the adsorption effect of the silk thread is
noticeably inferior to traditional medicine thread,
and the thread is not as easy to loop as traditional
threads or rubber bands.
121
a
b
c
Fig. 8.9 Anal stula low incision and high thread hanging therapy. (a) The probe enters the stula, (b) pull out
the rubber band, (c) cut the skin, tighten the ligation of the
rubber band
The Transformation fromSimple
Thread- Drawing toIncision
Thread-Drawing Therapy
Initially, when the thread-hanging method was
used to treat anal stula, the skin was not cut, but
the whole stula between the inner mouth and the
outer mouth was hung with medicated thread and
tightened, and heavy objects were suspended to
enhance the cutting effect. In the process of
slowly cutting the skin, muscles, etc., the patient
suffered great and unbearable pain. At the same
time, the threading process was long and so was
the recovery time.
Since it was recognized that the incision of the
skin and the stula below the deep external
sphincter muscle had little effect on anal function
when the suture was hung, the original wholelayer suture was changed to incising the stula
below the skin and the external sphincter muscle,
and only the stula above the deep external
sphincter was cut and hung (Fig.8.9). This does
not increase sphincter damage but can greatly
reduce the suffering of patients and shorten the
course of treatment. This treatment method of
low incision and high thread hanging is still the
main operative method of high anal stula threadhanging therapy today.
Change fromReal Line toVirtual
HangingLine
Inspired by Parks’s “Theory of Anal Crypt Gland
Infection” and the surgical method of anal stula
with sphincter preservation, it was recognized
that the complete elimination of the internal orice, anal duct, anal gland abscess, and the maintenance of unobstructed drainage are the
necessary conditions for the treatment of anal
stula, while the incisions of the sphincter were
not absolutely necessary conditions for the treatment of anal stula. The anal stula can be cured
without cutting the sphincter. Therefore, since
the late 1990s, doctors began using the “false
hanging line” (also known as oating hanging
line, slack hanging line) method to treat anal stula. Hollow suture is a method that does not
tighten the rubber band or cut the stula after
122
Fig. 8.10 Thread-drawing drainage and virtual threaddrawing therapy of anal stula
hanging the thread in the stula and only uses
the drainage effect of the rubber band to treat
anal stula (Fig. 8.10). In general, secretion
gradually decreases in the stula cavity until
there is no more purulent secretion left. When
the purulent cavity shrinks, the elastic band that
loosens the thread is gradually removed.
After adopting the method of virtual line, the
anal sphincter and its function can be better protected, and the number of incisions and tissue
damage can also be reduced. However, some
patients still were not cured after the removal of
the oating thread, and the recurrence rate of the
virtual line was higher than that of the real line.
That is, the main disadvantage of the virtual line
therapy is that the cure rate is not as high as that
of the real line therapy.
Change fromThread Hanging
toDrainageTube
In the process of using thread-hanging therapy, it
was found that in some cases, the stula was
located high and even extended to a plane that
was difcult to perform thread hanging (such as
the prostate or an even higher plane), or the dis-
R. Shi and L. Zheng
Fig. 8.11 Anal stula catheterization therapy
tance between the stula and the rectum was too
large and the tissue was thick, so the difculty of
thread hanging and the potential injury it could
cause were both large. At this point, the biggest
difculty of the thread-hanging operation was
that the line cannot be drawn from the rectal cavity after being hung in a high position. Even if the
line can be drawn, there is still a concern that it
will be extremely difcult to stop the bleeding if
bleeding occurs at the articial internal orice.
For such anal stulas, doctors used drainage
tubes or infusion straps in the high stula
(Fig. 8.11). When changing the dressing every
day after defecation, rst wash the wound cavity
with normal saline or metronidazole solution.
When the secretions in the lumen of the stula
lessen and become clear, withdraw the drainage
tube by a small amount (0.3–0.5 cm) outward
each day, until all the secretions are withdrawn.
Therefore, this method is widely used in the
treatment of similar stulas, with a very high success rate, and has gradually become a routine
practice in the treatment of anal stula.
The author believes that the essence of the
drainage tube method is the virtual hanging
method, and its principle is to create the necessary conditions for the healing of the high stula
through drainage. When using this method to
treat anal stula, the anal sphincter is basically
not damaged, and normal tissues are not cut open,
which reduces the damage to anal function.
However, there is also the disadvantage that the
cure rate of this form of relaxed hanging therapy
8 Surgical Treatment ofAnal Fistula
123
is lower than that of real hanging therapy. Suitable
candidates should be selected, the hardened stula wall should be removed as much as possible
during the operation, and the blood supply and
repairing ability of the tissue should be improved
in order to improve the success rate of drainage
tube therapy.
Change fromtheDrainage Tube Method
toVirtual andReal Thread Hanging
The essence of the drainage tube method is the
virtual thread hanging method. Although this
reduces the damage to anal function, this also has
the disadvantage that the cure rate is lower than
that of actual thread-hanging therapy.
Director Zheng Lihua summarized a method
for treating high anal stula that combined virtual and real thread hanging based on years of
clinical experience. This method is mainly aimed
at high anal stula with a stula position higher
than the anorectal ring, or high anal stula with a
high blind end position. The stula above the
inner opening and within the range of infection of
the anorectal ring was rmly connected with the
silk knot during the operation, and the high infection lesion above the anorectal ring was partially
cut off by the strangulation force of the silk
thread. About 7 days after the operation, some
infected lesions in the upper part were cut off,
and the ligation line became loose. The silk
thread was used to continue drainage of necrotic
infected tissues, and granulation took place. This
innovation completely relieved the pain of postoperative thread tightening.
At the same time, the rubber band was
replaced by silk threads. The multistrand silk
wire has a more smooth drainage effect, stronger
cutting force, and faster cutting speed than the
rubber strip, and the patient’s pain is signicantly reduced. In view of the biggest difculty
in the operation of line hanging, that the hanging
line cannot be drawn from the rectum cavity
after high line hanging, director Zheng used the
method of guiding through the intestinal cavity
with the index nger and pulling out the silk line
with the rubber band to accurately locate the
hanging line position. During the operation,
avoid bleeding at the articial stoma after tight-
ening the surgical knot. The clinical application
of virtual combined with real thread hanging
simplies the operation process, and has
achieved success in the treatment of high and
complex anal stula.
8.2.2.3 Therapeutic Principle ofThread
Hanging
Currently, there are ve main therapeutic principles of hanging line therapy (Fig.8.12).
The Eect ofSlowly Cutting
By means of the tight line contraction or elastic
force, compression ischemic necrosis can be generated locally in the cut tissue, which will slowly
disconnect and fall off, thus replacing the use of a
knife with a line. In this process, sphincter separation and tissue brosis repair are carried out at
the same time so that the broken end of the separated muscle has an attached fulcrum, and the
broken end of the separated muscle is connected
with the new scar tissue in the middle to form a
ring structure again, which can still maintain
functions such as anal constriction. Hu Bohu and
Shi Zhaoqi conducted experimental studies on
incising and hanging canine anal sphincters. The
results show that the width of scar between the
ends of incisions in the hanging group was signicantly smaller than that of the cutting group,
and the inuence on the static pressure and systolic pressure of the anal canal was signicantly
reduced compared with that of the cutting group
too. This shows that although thread-hanging
therapy can also damage anal function in a
degree, it is to a lesser extent, and on the whole,
it can better protect the anal function.
Foreign Body Irritation
Medicine thread or rubber band, as a foreign
body, can stimulate local tissues to produce an
inammatory response. Inammatory stimulation can cause the sphincter to be severed and
broken and to adhere to or x onto surrounding
tissues.
The Drainage Eect
When the hanging line is placed in the anal stula wound cavity, it has a good drainage effect,
124
Anorectal Ring
Hanging Wires
al anal function
Anorectal Ring
R. Shi and L. Zheng
Puborectalis Muscle
External Anal Sphincter
Incision therapy
cut open Hanging Wires
Thread hanging therapy
The muscles slowly
break apart and
adhere to the
surrounding tissues,
with the broken
ends separated
slightly
The muscle breaks and separates
Anal incontinence
cut
Fig. 8.12 Schematic diagram of thread-hanging therapy principle
which can make the secretions in the wound
cavity ow out along the hanging line (rubber
band) without accumulating, so that the wound
surface is kept clean, thus creating ideal condi-
Anorectal Ring
tions for healing. For Crohn’s disease patients
and some others that are not suited to open surgery, the hanging line drainage can greatly
reduce inammation of the tissues around the
Norm
8 Surgical Treatment ofAnal Fistula
125
anal stula, thus creating the conditions necessary for future surgery.
Marking Function
It can indicate the relationship between the outer
orice and the inner orice and indicate whether
the stula has been completely cut. Therefore, it
has a marking function.
Medicinal Eects
The traditional Chinese medicine thread has certain medicinal effects because it is cooked with
medicine that can reduce swelling, remove
necrotic tissue, and promote muscle growth. This
is the advantage of using traditional medicine
thread over rubber band or silk thread. As there
has been little clinical use of the medicine line
therapy contemporarily, many methods of cooking the thread properly have been lost. Lu Jingen
and others adopted modern silk thread as the
thread-hanging material and added some drugs
on the silk thread to play a similar role as
traditional medicine threads, inheriting some
characteristics of traditional thread-hanging therapy. However, the author believes that this still
cannot fully encapsulate the advantages of traditional medicine lines.
8.2.2.4 The Main Surgical Methods
Used inThread-Hanging
Therapy
internal sphincter, and external sphincter below
the inner opening, scratch and remove the
infected anal glands and the hardened and proliferated tissues around them, trim the wound, and
treat the mucous membranes on both sides of the
inner opening and the adjacent anus. The sinuses
are ligated with thick silk threads to enlarge the
wound surface of the internal opening and facilitate drainage.
For the stula above the deep part of the
external sphincter, use a ball-head probe with a
rubber band at one end to explore the deep stula, gently insert it into the top of the tube along
the lumen, and pull it out after the top of the tube
penetrates the rectal wall (if the patient has a perforation, the probe can pass into the rectum
through this perforation). Pull the probe, together
with the rubber band, out of the anus and tighten
the thread appropriately (Fig.8.13). In anal stula with a particularly high position, because of
the deep tube, it is difcult to pull the probe deep
into the high stula through the rectal wall.
Some people have proposed that with the aid of
instruments, a probe or a vascular clamp can be
inserted from the rectum and pulled out of the
anus through the stula.
For nonmain duct wounds of patients with
complex anal stulas, part of the wounds should
be sutured if necessary to reduce the wound surface area and shorten healing time.
Low-Position Incision andHigh-Position
Thread-Hanging Technique
Referred to as incision-hanging technique, or
external incision and thread-hanging technique.
It is suitable for high simple and high complex
anal stula. It is also recommended for patients
with weak sphincters or female anterior anal
stula.
Key points of operation: the treatment of stulas below the deep part of the internal orice and
external sphincter is basically the same as that of
anal stula incision or internal orice incision.
After cutting the low-level pipeline, before using
the high-level pipeline to hang the line, treat the
inner opening rst. Cut the skin of the anal canal,
Fig. 8.13 Low-position incision and high-position rubber band thread-hanging therapy for anal stula
126
R. Shi and L. Zheng
Low-Position Incision andHigh-Position
Virtual Thread Hanging
Also known as low-position incision and highposition loose thread-hanging technique, or
called low-position incision and high-position
oating thread-hanging technique, it is an
advancement based on incision and threadhanging therapy. Surgical style: it is suitable for
the treatment of high anal stulas and abscesses.
Key points of operation: it is basically the
same as the low-position incision and highposition thread-hanging technique. The only difference is that the thread is not tightened after it
is threaded. The two ends of the pulled-out rubber band are loosely ligated to form a rotatable
ring. When changing the dressing each day, one
must rotate the rubber band ring and ush the stula cavity with a liquid such as metronidazole or
normal saline.
It should be noted that the low incision and
high loose thread-hanging technique has higher
requirements for the right candidate than lowincision high-thread-drawing. If the stula wall is
thick, blood supply is not good, there are many
scar tissues after multiple operations, or if tissue
healing ability is poor, the former treatment will
easily fail. Therefore, the loose thread-hanging
technique is suitable for the cases of anal stula
with thin tube walls, good blood supply, tissue
regeneration, and healing ability. For anal stulas
with thicker walls, sometimes it is necessary to
use virtual thread therapy instead. In order to
improve the success rate of the operation, the
wall must be trimmed to remove the hardened
wall and improve the healing conditions of the
stula lumen.
Combination ofVirtual andReal ThreadHanging Techniques
The combination of virtual and real threadhanging methods is an innovative treatment that
combines the advantages of the gradual strangulation effect of real thread hanging and the postoperative drainage characteristics of virtual
thread hanging. It is suitable for high anal stulas, including high simple anal stulas and high
complex anal stulas, and it is also applicable to
refractory anal stula with repeated attacks.
Operation points: the specic method is that
during operation, make a radial incision to the
inner mouth from the dentinal line, about
3–4 cm in length, and the incision position is
generally on the same side as the outer opening
to fully drain the infection foci at the inner
opening. Cut the inner opening, extending 0.5–
1.0 cm upward, and extend downward to the
outside of the anal margin. Use curved hemostatic forceps to probe the upper end of the high
stula from this incision until the top of the stula is reached. Use your ngers to reach into
the intestinal cavity for guidance, and the tip of
the forceps to penetrate the stoma of the intestinal wall. Withdraw the nger, use 4–10 gauge
silk threads, tie one end to the ngertip, and put
it into the intestinal cavity. Open the hemostatic
forceps to clamp the thread, draw the silk thread
from the intestinal cavity through the stula,
gather the two ends, and x it with a knot.
Routine cleaning and dressing should be
changed once a day after the operation. Vaseline
gauze is drained, and the gauze is applied and
xed. About 7 days after the operation, the silk
thread is loose, and the virtual thread is drained
at this time. After the granulation tissue lls the
stula, it can be removed on the 20th day of the
operation (Fig.8.14).
It should be noted that the combination of virtual and real thread hanging is divided into two
stages: intraoperative real thread hanging and
postoperative virtual thread hanging. Intraoperative actual threading is the same as high
thread hanging. Low-position incision and high
thread hanging can be used. The difference is that
in the postoperative virtual thread hanging, the
ligation thread is loose, the thread is not tightened, and the thread is removed after 7 days after
the operation so that the ligation thread plays the
role of virtual hanging and drainage. At 20 days,
the suture is removed according to the granulation lling of the stula cavity.
Tunnel Thread-Hanging Surgery
In the 1980s, the Department of Traditional
Chinese Medicine Surgery of Longhua Hospital
applied thread-hanging therapy to the treatment
of anal stula for the rst time in China. This sur-