The fistulous tract is resected, the borders of the rectal orifice refreshed and closed with a single or double layer of absorbable stitches (a). The distal aspect of the de-epithelialized MPSF is fixed with 3 or 4 stitches to the anterior rectal wall, proximally to the location of the fistula to provide complete coverage of the rectal suture. The elasticity of the fat tissue allows the flap to adapt well and efficiently to the space created between the rectum and the prostate (b, c).