Perioperative management - Anal fistula, closure with Anal Fistula Plug® (AFP®)

  1. Indications

    • proximal, transsphincteric anal fistulas
  2. Contraindications

    • distal fistulas
    • rectovaginal fistulas
  3. Preoperative Diagnostics

    • Proctological examination: inspection, palpation, proctoscopy, rectoscopy
    • additionally: fistula probing
    • in special cases: anal endosonography, MRI
  4. Special Preparation

    • Usually, orthograde bowel lavage is required (generally recommended, but not supported by strong evidence).
    • A fistula without acute inflammatory changes must be present. This is usually achieved by inserting a thread (e.g., Vessel-Loop®) for 8-12 weeks.
  5. Informed consent

    General:

    • Bleeding
    • Thrombosis
    • Embolism etc.

    Specific:

    • Fistula persistence
    • Recurrence
    • Abscess
Anesthesia

Depending on the general condition of the patient:Intubation anesthesia (Intubation anesthesia, Lar

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