Perioperative management - Anal fistula, closure with Anal Fistula Plug® (AFP®) - general and visceral surgery
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Indications
- Proximal transsphincteric anal fistulas
Contraindications
- Distal fistulas
- Rectovaginal fistulas
Preoperative diagnostic work-up
- Proctological examination: Inspection, palpation, proctoscopy, rectoscopy
- In addition: Fistula probing
- In special cases: anal endosonography, MRI
Special preparation
- In most cases oral antegrade intestinal lavage (generally recommended, although the level of evidence is not high)
- The fistula must be without acute inflammatory changes. This is usually achieved with a seton (e.g. Vessel-Loop®) in place for 8-12 weeks.
Informed consent
General:
- Bleeding
- Thrombosis
- Embolism etc.
Specific:
- Persistence of the fistula
- Recurrence
- Abscess
Anesthesia
Positioning
Operating room setup
Special instruments and fixation systems
Postoperative management
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