Verify the indication by probing the fistula, then sparingly excise the external opening of the fistula. Follow this by flushing the fistula tract.
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Excising the fistula opening
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Inserting the plug
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
Anchor the plug, usually with 2 PDS sutures (3-0 or 2-0) through the internal sphincter or muscular
Anchor the plug, usually with 2 PDS sutures (3-0 or 2-0) through the internal sphincter or muscular
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