Perioperative management - Anal fistula, plastic closure with rectal mucosa advancement flap - general and visceral surgery
You have not purchased a license - paywall is active: to the product selection
- Non-infected intermediate transsphincteric fistulas
- Non-infected suprasphincteric fistulas
- Non-infected high transsphincteric fistulas
- Acute inflammation
Note: Chronic inflammatory bowel disease is not a contraindication for this surgical technique.
Preoperative diagnostic work-up
- Carry out the necessary diagnostic work-up beforehand while treating the acute inflammation. As a rule, the first step involves passing a silicone thread seton through the fistula track.
- If the course of the fistula is unclear or if there are persistent fistula or abscess cavities, this may require endosonography or MRI studies.
Recommendation Intestinal lavage (not evidence-based)
- Embolism etc.
- Resulting incontinence
- Sensory deficit with incontinence symptoms or stenosis
- Stenosis through scarring
- Secondary wound healing
- Persistent fistulization and recurrence in 30-40% of cases
Operating room setup
Special instruments and fixation systems