Ambulatory Excision of Perianal Duplicatures

published: 06. 04. 2010

MUDr. Pavel Zbořil, PhD. Vysloužil K., Klementa I., Starý L., Skalický P., Růžička V.

I. Surgery Clinic. Faculty Hospital in Olomouc

Summary

For successful outpatient treatment of perianal duplicatures, it was necessary to solve two main problems. First was bleeding from wounds following excision of perianal duplicatures, which is often marked and “pulsating”, as well as to accelerate defect healing after excision so as to eliminate or minimize sick leave following this outpatient procedure. To effectively stop acute bleeding we use Traumastem P, which after applying to a tampon we apply to the bleeding site and by compression we facilitate its effect. Traumastem also has a significant haemostatic effect, which we spray directly onto the bleeding site, where it reacts and creates a strongly adhering coagulum, which has significant haemostatic properties. This effect may also be potentiated by applying compression in the form of tampon or longuette. After cessation of acute bleeding, as prevention against future seepage, surgical haemostatic materials are used, which adhere to the wound, or bleeding lesion, and are left in situ for approximately 12 hours. After stopping the bleeding, hydrocortisone and epithelisation cream is applied to the defects to support healing by significantly decreasing secretion from the wound and also significantly decreasing healing time by facilitating epithelisation. At outpatient check-ups, wound surfaces treated as such are cleanly granulated without necrotic coating and with minimal surrounding redness. The total healing time is generally 2 weeks, whereas after 4 days the patients are almost without troubles. This effective healing not only lessens the patient’s pain, but also improves the comfort of the patient and allows a more rapid return to daily activities.