This document describes the SLOFT procedure for treating an intersphincteric fistula. It involves probing the tract, injecting xylocaine at the internal opening, incising and dissecting around the probe, tying off the tract, transecting it, excising any infected tissue, performing a dye test to ensure there is no connection to the anus, possibly coring or curetting the distal tract, and closing wounds. Follow up is done after 15 days to check for collections via physical exam and ultrasound. The procedure aims to ligate the tract to eliminate drainage from the anus and allow healing.

1. SLOFT
(Submucosal Ligation Of Fistula Tract)
Dr D.U.Pathak
WhatsApp 94251-52747
Email : sloftsurgery@gmail.com
Shalby hospital, Jabalpur
(M.P) India

2. Inter sphincteric fistula at 2- O clock
• External opening at
2-O clock
• Tract palpable up to 3
cms

3. Probing
• Gentle probing
• Probe pulled out of anal
canal

4. Injection
• Inj Xylocaine adrenaline
at muco cutaneous
junction, just 1 cm
beyond the internal
opening, for hydro
dissection and
blanching

5. Incision
• At muco cutaneous
junction

6. Dissection around the probe
• Dissection around the
indwelling probe with
artery forceps
• Passing an aneurysm
needle and taking
suture with it’s help

7. Tying the tract
• The probe is taken out
and tract tied,
transfixed

8. Transection
• Tract is cut near to the
tie
• A lateral segment,
which is infected
crypto-glandular
portion, is excised and
sent for biopsy

9. Dye test
• After transecting the
tract, dye is instilled
from external opening,
which comes out from
perianal area instead of
anus
• Cotton squab in anus is
seen without soiling
with dye

10. Coring
• Coring is done of distal
tract if it is mature.
• Otherwise only
curetted, if it is an
abscess fistula complex
with tract not well
formed
• The external
epithialised opening
should remain patent to
drain the infection

11. Perianal wound closed
• Should be left open
with a small pack if inter
sphincteric space is
infected
• If the tract was mature
and total excision was
possible then it can be
closed primarily

12. External opening wound
• Loose packing done for
one day
• No post op packing or
dressings, only cleaning
and warm sitz bath is
enough

13. • Post operative follow up after 15 days or SOS
if patient has any problem
• P/R and a check USG is done on 15th day to
see for any collection if any and further visits
decided accordingly

14. Thanks...
I am happy with the
results...