Perioperative management - Fistulectomy with primary sphincter reconstruction

• intermediate transsphincteric, non-irritating fistulas
• high transsphincteric, non-irritating fistulas
• suprasphincteric, non-irritating fistulas

• acute inflammation
• abscess

Note: Chronic inflammatory bowel diseases do not constitute a contraindication for this surgical method.

• The necessary diagnostics are already performed in advance during the therapy of the acute inflammation. Typically, a drainage silicone thread is initially placed.
• In cases of unclear fistula course or persistent fistula or abscess cavities, an endosonography or an MRI examination may be necessary.

Recommendation: Bowel lavage (not evidence-based)

General:

• Bleeding
• Thrombosis
• Embolism, etc.

Specific:

• Consecutive incontinence
• Sensory deficit with incontinence complaints or stenosis
• Stenosis due to scar formation
• Secondary wound healing
• Abscess
• Suture dehiscence
• Fistula persistence and recurrence in up to 10% (depending on the fistula height)