Fistulectomy with primary anal sphincter reconstruction - general and visceral surgery

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date of publication: 26.04.2009

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  • Exploring and inspecting the fistula

    Video
    53-4

    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. Now insert the Parks retractor.

  • Excising the external opening of the fistula

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    In order to ensure a wide external wound for drainage, generously excise the external opening of the fistula and then core out the fistula tract like a funnel along the seton.

  • Dividing the anal sphincter

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    Divide the anal sphincter completely along the fistula-bearing part.

    Tip: Use the previously inserted probe as a guide.

  • Excising the bed of the fistula

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    Completely excise the bed of the fistula with electrocautery.

  • Reconstructing the anal sphincter

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    Reconstruct the divided anal sphincter by coapting the ends with several full--thickness interrupted sutures. Cover this wound by closing the anoderm with interrupted sutures. Leave the external lateral wound open to heal by secondary healing.