Anal fistula, closure with Anal Fistula Plug® (AFP®) - general and visceral surgery

You have not purchased a license - paywall is active: to the product selection
  1. Excising the fistula opening
  2. Inserting the plug
  3. Anchoring the plug
date of publication: 22.10.2009

Single Access

Access to this lecture
for 3 days

€4.99 inclusive VAT

payment

webop-Account Single

full access to all lectures
price per month

for the modul: vascular surgery

from 8,17 €

ask it here

hospitals & libraries

for the modul: vascular surgery

from 390,00 euros

ask it here

  • Excising the fistula opening

    Video
    33-4

    Verify the indication by probing the fistula, then sparingly excise the external opening of the fistula. Follow this by flushing the fistula tract.

  • Inserting the plug

    Paid content (video)
    Paid content (image)

    Insert a stay suture. Pull the tapered end of the AFP attached to the stay suture into the tract through the internal opening and the tract to the outside. Keep the plug under slight tension until it is firmly seated in the lumen of the fistula. Trim the internal excess such that the plug is flush with the mucosa.

  • Anchoring the plug

    Paid content (video)
    Paid content (image)

    Anchor the plug, usually with 2 PDS sutures (3-0 or 2-0) through the internal sphincter or muscularis propria. With the proper stitch direction, this should also close the mucosa and anoderm respectively. Alternatively, close it with a new suture. Some authors dissect a mucosal flap akin to that used in plastic fistula closure. Finally, trim the external excess to just below skin level. The plug does not have to be anchored here.