Perioperative management - Fistulectomy with primary anal sphincter reconstruction - general and visceral surgery
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- Non-infected intermediate transsphincteric fistulas
- Non-infected high transsphincteric fistulas
- Non-infected suprasphincteric 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
- Wound dehiscence
- Fistula persistence and recurrence in up to 10% (depending on level of fistula)
Operating room setup
Special instruments and fixation systems