Rectal Advancement Flap

Repair of an anal fistula involves covering the internal opening to prevent ongoing communication between the anus and the fistula tract. If the internal opening is high in the anal canal a rectal advancement flap is preferred using a flap of mucosa and the underlying muscle to cover the internal opening. This repair also involves repairing the defect in the sphincters, and cleaning (curetting) or excising the fistula tract.

What to expect post operatively after a rectal advancement flap

Following your procedure, you will recover for an hour until the effects of sedatives have worn off. You should not drive yourself home after your procedure and should have someone organised (a friend or relative) to accompany you.

You should remain on stool laxatives and simple analgesics for 1 week. We recommend taking twice daily a tablespoon of natural psyllium husk (Metamucil® or Fibogel®), and 30ml of lactulose (Duphalac®). For pain we recommend after each meal 400mg of ibuprofen (Brufen®) and 1g of paracetamol. Opioid medications (Codeine and Morphine) should be avoided as they cause constipation.

Twice daily warm salt water (sitz) bathing to the anal region is soothing and antiseptic, and should be done for 1 week following your procedure.

You should follow up with your colorectal surgeon in 6 weeks to review your wound and discuss further management if indicated.

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