Seton drainage in high transsphincteric anal fistula

With the patient in lithotomy position, perform a digital rectal examination followed by slow and careful dilation of the anal sphincter. Insert the Parks retractor After careful retrograde probing and instillation of contrast agent, the inner internal opening of the fistula is found high in the anal canal at 5 o'clock.

After carefully debriding the fistula tract, excise the tissue around the external opening. The indurated ischioanal tissue delimits it from the healthy surrounding tissue. The plan is to create a funnel-shaped wound with a wide opening.

Perform the lateral incision where the tissue becomes soft, i.e. where it is no longer inflamed or scarred.