46288 Closure of anal fistula with rectal advancement flap

Name of the Procedure:

Closure of Anal Fistula with Rectal Advancement Flap (also known as Rectal Mucosal or Anorectal Advancement Flap)

Summary

This surgical procedure involves covering the internal opening of an anal fistula with a flap of rectal mucosa (the inner lining of the rectum) to promote healing and closure of the fistula.

Purpose

The procedure is designed to treat anal fistulas, which are abnormal connections between the anal canal and the skin around the anus. The goal is to close the fistula to prevent infection, discharge, and discomfort.

Indications

• Persistent anal drainage or discharge
• Pain or discomfort around the anus
• Recurrent infections or abscesses
• Non-healing after other treatments, such as antibiotics or drainage

Preparation

• The patient may be advised to fast for several hours before the procedure.
• Bowel preparation might be required to clean the colon.
• Adjustments in medications, especially blood thinners, as guided by the doctor.
• Pre-operative assessments, including blood tests, imaging studies, and possibly a colonoscopy.

Procedure Description

1. Anesthesia: The procedure is usually performed under general anesthesia or spinal/epidural anesthesia.
2. Positioning: The patient is positioned for optimal access to the anal region.
3. Incision: The surgeon makes an incision to access the fistula.
4. Dissection: The fistula tract is carefully dissected.
5. Flap Creation: A flap of rectal mucosa, submucosa, and muscle is created.
6. Closure: The internal opening of the fistula is closed with sutures, and the flap is advanced over the closure site and secured.

Duration

The procedure typically takes about 1 to 2 hours.

Setting

Hospital operating room or outpatient surgical center.

Personnel

• Colorectal surgeon
• Nurses
• Anesthesiologist

Risks and Complications

• Infection
• Bleeding
• Recurrence of the fistula
• Pain or discomfort
• Urinary retention
• Postoperative complications, such as flap necrosis or strictures

Benefits

• Relief of symptoms, such as discharge and pain
• Reduced risk of recurrent infections
• Improved quality of life Benefits may be noticed within a few weeks post-procedure.

Recovery

• Patients may need to stay in the hospital for observation, usually for 1-2 days.
• Pain management with prescribed medications.
• Instructions on wound care and maintaining hygiene.
• Restriction on heavy lifting and strenuous activities for a few weeks.
• Follow-up appointments to monitor healing.

Alternatives

• Seton placement (a thread to allow drainage while healing)
• Fistulotomy (cutting open and draining the fistula)
• Fibrin glue or plug
• Each alternative has its own benefits and risks, which should be discussed with the healthcare provider.

Patient Experience

• Patients might feel discomfort around the surgical area initially.
• Pain is managed with medications.
• Most patients can resume normal activities within a few weeks.
• Proper wound care and follow-up are crucial for optimal recovery.

Remember to consult with a healthcare provider for personalized information and guidance.