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Fistuloscopy Procedure at King's College

What is a fistuloscopy?

A fistuloscopy is a diagnostic procedure used during surgeries for anal fistula or abscess when performing VAFFT technique.

The fistuloscopy takes place as a diagnostic phase of the surgery before moving to the operative phase (same session).

The purpose of this phase is to correctly locate the internal fistula opening and possible secondary tracts or abscess cavities. We insert the fistuloscope through the external opening (no extra cut) with the glycine–mannitol solution already running.

The obturator is visible at the lower edge of the screen to ensure the correct orientation of the fistuloscope. The fistula pathway will appear clearly on the screen.  We put the fistuloscope against it and wait for the glycine–mannitol solution to open the fistula tract. Then, we simply advance the fistuloscope along the pathway using slow movements, left/right and up/down. These manoeuvres allow the fistula to accommodate the fistuloscope, and the fistula is straightened.

Anaesthesia facilitates this process. Optimal vision of the lumen of the fistula is ensured by the continuous jet of irrigation solution reaching as far as the internal opening, which is the end of the fistula tract  at this point, the assistant inserts a retractor and the lights in the operating theatre are dimmed so that it is easy to see the fistuloscope light in the rectum.

Then after confirming the fistula location and seeing the all tract and locating the internal opening the second phase – surgical phase – starts.