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Mucosal advancement Flap, Step by step
- Position patient in lithotomy position
- Place the intra-anal retractor
- Identify fistula site
- Canulate and brush the fistula tract (or flush with hydrogen peroxide,or both)
- Excise the intra-anal fistula site (elliptical shape)
- Create a wide flap by extending the proximal anorectal wall upwards
- Close the internal fistula opening with absorbable suture
- Further dissect the flap above the fistula including a thin layer of internal sphincter
- Prepare the advancement flap and optimize the size before suturing
- Complete the repair with single sutures
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