Louis' operation is very well-known. It required 3 hrs. Special instruments were designed by Felix, his surgeon. The KIng took great interest in the novel instruments. Felix had practiced on all who were willing and who could be found with fistulae like the King's. Louis' had developed after unsuccessful "treatment" of a perianal abscess. As I recall, those prisoners who agreed to operation were granted pardons. Louis gave little sign of pain during the long ordeal but he did heal well. It is correct that Felix did not operate again though his services were sought by many. The King gave him a noble title and an estate. Louis' dental surgeon, on the other hand, so badly tore the king's palate that he had speech and eating problems for the rest of his life. Near the end, amputation might have saved his life but his surgeons dithered...much like Washington's.
Sometimes those skinny vessel loops are not enough. For a large cavity I find a quarter inch penrose drain or even a Malecot catheter along side the seton is better. I take out the larger drains first and leave the setons in longer, especially in the midline. You need to talk to your patients about the follow up procedure. Occasionally a patient will just want a midline fistulotomy to get it over with. The LIFTs and advancement flaps are not slam dunks. Dr. Hanley made a great contribution by avoiding the huge step off deformities, and it is surprising what some male patients will tolerate in terms of sphincterotomy.
I just got a perianal abscess drained. What a great thanks to doctors who perform unnecessary surgery on otherwise healthy individuals. What they will never tell you in school is many, like half don’t need treatment. Conservative or home treatment is good. Needle aspiration if it needs to go. But lmao, scarring people up for the sake of getting rid of it??? This is 30% every EVERY drainage & incision.
Louis' operation is very well-known. It required 3 hrs. Special instruments were designed by Felix, his surgeon. The KIng took great interest in the novel instruments. Felix had practiced on all who were willing and who could be found with fistulae like the King's. Louis' had developed after unsuccessful "treatment" of a perianal abscess. As I recall, those prisoners who agreed to operation were granted pardons. Louis gave little sign of pain during the long ordeal but he did heal well. It is correct that Felix did not operate again though his services were sought by many. The King gave him a noble title and an estate. Louis' dental surgeon, on the other hand, so badly tore the king's palate that he had speech and eating problems for the rest of his life. Near the end, amputation might have saved his life but his surgeons dithered...much like Washington's.
Sometimes those skinny vessel loops are not enough. For a large cavity I find a quarter inch penrose drain or even a Malecot catheter along side the seton is better. I take out the larger drains first and leave the setons in longer, especially in the midline. You need to talk to your patients about the follow up procedure. Occasionally a patient will just want a midline fistulotomy to get it over with. The LIFTs and advancement flaps are not slam dunks. Dr. Hanley made a great contribution by avoiding the huge step off deformities, and it is surprising what some male patients will tolerate in terms of sphincterotomy.
Thank you for this video!
I just got a perianal abscess drained.
What a great thanks to doctors who perform unnecessary surgery on otherwise healthy individuals. What they will never tell you in school is many, like half don’t need treatment. Conservative or home treatment is good. Needle aspiration if it needs to go.
But lmao, scarring people up for the sake of getting rid of it??? This is 30% every EVERY drainage & incision.