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

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.

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

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

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

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

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.