I am totally stumped 
Any help/direction offered would be greatly appreciated. The op report is below.
PREOP DX:
1. RECURRENT RIGHT PERIANAL SACROCOCCYGEAL SINUS OPENING WITH RECURRENT CYST.
2. NEW SINUS OPENING WITH RECURRENT CYST ON THE LEFT PERINEAL AREA.
POSTOP DX:
PERIANAL SINUS AND FISTULAE
OPERATIONS:
EXCISIONAL DEBRIDEMENT AND CLOSURE OF PERIANAL SINUS TRACT AND FISTULAE
FINDINGS:
THERE IS TWO SINUS OPENINGS, ONE IS IN THE RIGHT PERIANAL SACROCOCCYGEAL REGION. IT IS ABOUT 2.5 TO 3.0 CM FROM THE ANAL OPENING AND THEN ANOTHER SINUS OPENING NOTES AT THE LEFT PERINEAL REGION. THERE IS A SINUS TRACT COMMUNICATING WITH TWO SINUS OPENINGS. THERE IS ALSO A BLIND TRACT THAT GOES DOWN TO THE PERIANAL REGION.
PROCEDURE:
THE PATIENT WAS GIVEN GENERAL ANESTHESIA AND THEN PLACED IN THE PRONE POSITIONS. PLEXIPULSE WERE APPLIED ON BOTH FEET. THE PERINALA REGION AND PERINEAL AREAS WERE THEN PAINTED WITH CHLORAPREP FOLLOWED BY APPLICATION OF ROUTINE STERILE DRAPES. A FIRST MADE AN ELLIPTICAL INCISION AT THE AREA OF THE LEFT PERINEAL SINUS OPENING AND FOLLLOWED A TRACT THAT GOES ALONG THE SUBCUTANEOUS TISSUE, AROUND THE ANUS, WHICH THEN COMMUNICATES INTO THE ORIGINAL OLD AND RECURRENT SINUS OPENING AT THE RIGHT PERIANAL SACROCOCCYGEAL AREA. THE TRACT ALSO IN THE MIDDLE SEEMS TO EXTEND DEEP INTO THE PERIANAL REGION, BUT ENDS IN A BLIND SPOT. THE WHOLE TRACT AND SINUS OPENINGS WERE EXCISED COMPLEXLY, MAKING A CONNECTING INCISION BETWEEN THE TWO SINUS OPENINGS. THE WOUND WAS THEN IRRIGATED COPIOUSLY WITH SEVERAL LAYERS OF INTERRUPTED BURIED KNOW #3-0 VICRYL SUTURE MATERIAL AND THEN THE SKIN WAS THEN CLOSED WITH A SIMPLE INTERRUPTED #3-0 PROLENE SUTURE MATERIAL. INDERMIL SOLUTION WAS THEN APPLIED FOLLOWED BY APPLICATION OF STERILE DRESSING. THE PATIENT TOLERATED THE PROCEDURE WELL AND LEFT THE OPERATING ROOM IN STABLE CONDITION.
Any help/direction offered would be greatly appreciated. The op report is below.PREOP DX:
1. RECURRENT RIGHT PERIANAL SACROCOCCYGEAL SINUS OPENING WITH RECURRENT CYST.
2. NEW SINUS OPENING WITH RECURRENT CYST ON THE LEFT PERINEAL AREA.
POSTOP DX:
PERIANAL SINUS AND FISTULAE
OPERATIONS:
EXCISIONAL DEBRIDEMENT AND CLOSURE OF PERIANAL SINUS TRACT AND FISTULAE
FINDINGS:
THERE IS TWO SINUS OPENINGS, ONE IS IN THE RIGHT PERIANAL SACROCOCCYGEAL REGION. IT IS ABOUT 2.5 TO 3.0 CM FROM THE ANAL OPENING AND THEN ANOTHER SINUS OPENING NOTES AT THE LEFT PERINEAL REGION. THERE IS A SINUS TRACT COMMUNICATING WITH TWO SINUS OPENINGS. THERE IS ALSO A BLIND TRACT THAT GOES DOWN TO THE PERIANAL REGION.
PROCEDURE:
THE PATIENT WAS GIVEN GENERAL ANESTHESIA AND THEN PLACED IN THE PRONE POSITIONS. PLEXIPULSE WERE APPLIED ON BOTH FEET. THE PERINALA REGION AND PERINEAL AREAS WERE THEN PAINTED WITH CHLORAPREP FOLLOWED BY APPLICATION OF ROUTINE STERILE DRAPES. A FIRST MADE AN ELLIPTICAL INCISION AT THE AREA OF THE LEFT PERINEAL SINUS OPENING AND FOLLLOWED A TRACT THAT GOES ALONG THE SUBCUTANEOUS TISSUE, AROUND THE ANUS, WHICH THEN COMMUNICATES INTO THE ORIGINAL OLD AND RECURRENT SINUS OPENING AT THE RIGHT PERIANAL SACROCOCCYGEAL AREA. THE TRACT ALSO IN THE MIDDLE SEEMS TO EXTEND DEEP INTO THE PERIANAL REGION, BUT ENDS IN A BLIND SPOT. THE WHOLE TRACT AND SINUS OPENINGS WERE EXCISED COMPLEXLY, MAKING A CONNECTING INCISION BETWEEN THE TWO SINUS OPENINGS. THE WOUND WAS THEN IRRIGATED COPIOUSLY WITH SEVERAL LAYERS OF INTERRUPTED BURIED KNOW #3-0 VICRYL SUTURE MATERIAL AND THEN THE SKIN WAS THEN CLOSED WITH A SIMPLE INTERRUPTED #3-0 PROLENE SUTURE MATERIAL. INDERMIL SOLUTION WAS THEN APPLIED FOLLOWED BY APPLICATION OF STERILE DRESSING. THE PATIENT TOLERATED THE PROCEDURE WELL AND LEFT THE OPERATING ROOM IN STABLE CONDITION.
