LAUSR

INTRODUCTION Currently there are many surgical options in the management of complex anal fistulas and transanal advancement flap is an attractive sphincter-sparing procedure. This technique allows the coverage of the primary opening and healing of approximately 78-80% of fistulas (1). Use of full-thickness rectal flap has been shown to increase success rates [2-4]. In our institution, transanal flap is the chosen technique for patients with a criptoglandular complex perianal fistula, We exclude rectilinear transsphincteric fistulas ,especially those which are anterior and in women. In the latter , we prefer to carry out a ligation of the intersphincteric fistula tract (LIFT procedure)) CASE PRESENTATION: We present the case of a 56-year-old man with a symptomatic complex fistula following a perianal abscess. Endoanal ultrasound showed a high tract passing through the upper third of the anal canal, with the internal opening at the posterior dentate line . The patient underwent a full-thickness transanal flap and is demonstrated step by step in this video. . The patient received preoperative mechanical bowel preparation. Postoperatively, the patient took a liquid diet for 3 days with loperamide to restrict the passage of stools. His postoperative course was uneventful. Follow up in out patients confirmed he had no further symptoms and the fistula remained healed. As an introduction we present how to demonstrate a transanal flap using a model anal canal made with modeling paste. CONCLUSION The transanal advancement flap repair is an effective technique in the management of complex anal fistula.