Before the treatment with the Pressfit® anal fistula plug, a loose seton is placed in the fistula; it is kept in place for a minimum period of two months or until complete reduction of the residual abscess cavity The use of a loose seton promotes drainage of the fistula and makes the fistulous tract more regular and cylindrical.
All patients are surgically operated under spinal anesthesia in the lithotomy position. The anal cavity having been explored with an anal retractor.
After two months or more the seton is removed and an accurate curettage of the fistula is performed with the use of a brush, in order to have a complete removal of fibrous tissues and corpuscular waste contained in the fistula tract, promoting bleeding from the fistulous tissues.
- Pressfit® anal fistula plug must be hydrated in saline solution for 5-10 minutes, according to the instructions for use.
- Fix a non-absorbable suture to the distal end of the plug.
- Use the suture like a probe and insert it in the fistulous tract from the internal opening to the external one.
- The plug will have the larger part positioned in the internal opening and the smallest one exceeding from the external opening.
- Suture the larger part of the plug in the internal opening with 2/0 absorbable suture.
- Close the internal orifice with a small mucosal flap.
- Cut the excess part of the plug from the external opening and fix it with another 2/0 absorbable anchor point. – Enlarge the external opening with a scalpel blade to promote drainage and a faster closure of the wound.
- A transanal gauze is put in place for 12 hours after surgery to prevent contamination of wounds and allow compression of the flap.