Anal fistula, plastic closure with rectal mucosa advancement flap - general and visceral surgery

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date of publication: 26.04.2009

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  • Exploring and inspecting the fistula

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    52-4

    First inspect the non-infected healed fistula with its previously inserted seton. Probe the fistula through its external opening and perform a digital rectal examination.

  • Excising the external fistula opening

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    52-5

    Now start with the funnel-shaped excision of the fistula along its track.

  • Excising the internal fistula opening

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    Insert the anal retractor and dissect the internal opening of the fistula. Follow the fistula track and sparingly excise the internal fistula opening.

  • Dissecting the advancement flap

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    With the electric diathermy carefully dissect the mucosal flap required to cover the defect.

  • Suturing the internal fistula opening

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    Close the internal fistula opening with full-thickness sutures, while the external fistula opening is left to heal by second intention.

  • Advancement flap

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    Cover the rectoanal defect with the previously prepared mucosal flap and secure it with several interrupted sutures. At the end carry out a final inspection.