Anal fistula: Rectal Advancement

Consider where fistula cannot be laid open
Do not do unless acute sepsis settled
Flap raised in intersphincteric plane and includes mucosa and internal sphincter
Full bowel prep
If anterior, prone in Jack knife position
Mark flap out with diathermy
Commences 5-10mm below internal opening and 10-15mm either side
Intersphincteric place infiltrated with LA/adenaline
Begin mobilisation in lateral virginal tissue, identify plane, then dissect toward track
Tension free flap suture with 3-0 PDS encompassing internal sphincter in flap and anal canal (Do not do too low as this will cause severe pain and urgency
Infant feeding tube into external opening to drain