Perioperative management - Anal fistula, plastic closure with rectal mucosa advancement flap

• Non-infected intermediate transsphincteric fistulas
• Non-infected suprasphincteric fistulas
• Non-infected high transsphincteric fistulas

• Acute inflammation
• Abscess

Note: Chronic inflammatory bowel disease is not a contraindication for this surgical technique.

• 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)

General:

• Bleeding
• Thrombosis
• Embolism etc.

Specific:

• Resulting incontinence
• Sensory deficit with incontinence symptoms or stenosis
• Stenosis through scarring
• Secondary wound healing
• Abscess
• Persistent fistulization and recurrence in 30-40% of cases