Length of follow-up after fistulotomy and fistulectomy associated with endorectal advancement flap repair for fistula in ano

2007 ◽  
Vol 95 (4) ◽  
pp. 484-487 ◽  
Author(s):  
H. Ortiz ◽  
M. Marzo ◽  
M. de Miguel ◽  
M. A. Ciga ◽  
F. Oteiza ◽  
...  
Keyword(s):  
Advancement Flap ◽  
Fistula In Ano ◽  
Endorectal Advancement Flap ◽  
Flap Repair

scholarly journals A novel modification of the Endorectal Advancement Flap for complex anal fistulas: surgical technique and outcomes

2020 ◽  
Author(s):  
Hassan Al-Turaihi ◽  
Blears Elizabeth ◽  
Sugumar Kavin ◽  
Deshmukh Maya ◽  
Deshmukh Ganesh
Keyword(s):  
Fecal Incontinence ◽  
Advancement Flap ◽  
Absorbable Suture ◽  
Internal Opening ◽  
Anal Fistulas ◽  
Fistula In Ano ◽  
Endorectal Advancement Flap ◽  
Flap Failure ◽  
Complex Fistula

Abstract Background Fistula-in-ano is a common problem encountered by surgeons which can be classified as either simple or complex. Complex fistulas (CF) cause higher morbidity and are much more challenging to treat. Although numerous treatment options are available for CF, none are proven to be 100% effective. The endorectal advancement flap (EAF) procedure was developed as an alternative to conventional surgical treatments for CF. Herein, we describe a novel modification of the EAF procedure along with surgical outcomes in terms of recurrence, fecal incontinence and factors associated with flap failure. Methods A retrospective review of patients with complex fistula-in-ano who underwent EAF between 2004-2019 was done. The conventional EAF procedure was modified by performing transverse imbrication of the internal sphincter over the internal fistula opening. The incidence of post-operative recurrence and fecal incontinence were calculated from chart documentation at the last available date of follow-up. Also, the association between various clinical and demographic factors and post-operative flap failure were calculated using Chi-squared test and student’s t-test or Mann-Whitney U test with statistical significance at alpha <0.05. Results With a median follow-up of 6.6 months (range: 1.6-84.5 months), 99 patients with CFs underwent a modified EAF. Of these, 93% (92/99) had a successful procedure, 7% (7/99) experienced recurrence and 3% (3/99) experienced postoperative fecal incontinence. Systemic steroid or immunomodulatory therapy use (p=0.001) and patients with diagnosed inflammatory bowel disease (p<0.0001) were associated with increased rate of flap failure.Conclusion EAF with transverse imbrication of the internal opening using interrupted, absorbable suture is an effective technique to treat complex or recurrent anal fistulas. It is associated with a low risk of recurrence (7%) and fecal incontinence (3%) and a valid treatment option for complex fistula-in-ano.

Fistulectomy and endorectal advancement flap repair for cryptoglandular anal fistula: recurrence and functional outcome over 10 years of follow-up

2021 ◽  
Author(s):  
Carlos Chaveli Diaz ◽  
Irene Esquiroz Lizaur ◽  
José Marzo Virto ◽  
Fabiola Oteiza Martínez ◽  
Gregorio Gonzalez Álvarez ◽  
...  
Keyword(s):  
Functional Outcome ◽  
Anal Fistula ◽  
Advancement Flap ◽  
Endorectal Advancement Flap ◽  
Flap Repair ◽  
Fistula Recurrence

Repeat endorectal advancement flap after flap breakdown and recurrence of fistula-in-ano - is it an option?

2012 ◽  
Vol 14 (11) ◽  
pp. 1389-1393 ◽  
Author(s):  
S. Stremitzer ◽  
S. Riss ◽  
P. Swoboda ◽  
B. Dauser ◽  
P. Dubsky ◽  
...  
Keyword(s):  
Advancement Flap ◽  
Fistula In Ano ◽  
Endorectal Advancement Flap

A New Surgical Device for Minimally Invasive “Core-Out” Excision of High Fistula-in-Ano

2013 ◽  
Vol 7 (1) ◽  
Author(s):  
Meysam Esmaeili ◽  
Siamak Najarian ◽  
Mohsen T. Kashani
Keyword(s):  
Thin Layer ◽  
Fistulous Tract ◽  
Thick Layer ◽  
Advancement Flap ◽  
Cannulated Screw ◽  
Healthy Tissue ◽  
Fistula In Ano ◽  
External Orifice ◽  
Flap Repair ◽  
Surgical Device

Core fistulectomy with endorectal advancement flap repair has been reported as a safe and effective technique for treatment of high fistula-in-ano. A number of rigid and flexible fistulectomy sets have already been fabricated pursuing the objectives of facilitating the procedure of this conservative surgical technique and reducing its risks of continence impairment. Two different methods (the method of scraping the granulation tissue of fistula and the method of separating and removing a thin layer from inside of tract) have been served in these sets for obliterating the abnormalities. In this work, with the aim of minimizing invasion to healthy tissue encircling the fistula, specially sphincter muscles, we designed and fabricated a new flexible fistulectomy device, which uses the second mentioned method. The new set separates an approximately 2.5-mm-thick layer from inside of the fistulous tract, by rotating a special tubular blade around its axis and moving the blade along the fistulous tract from external orifice toward the internal orifice. At the same time, the separated tissue may be removed from the fistulectomy lumen by rotating a special cannulated screw embedded coaxially inside the tubular blade. A flexible guidewire was used for identifying the tract path and guiding the device along it. We used the new set for excising 10 curved fistula models of approximately 16 cm length and 1.5 mm diameter, which were created in cubic pieces of fresh cow muscle as test specimens. After removing the device, each specimen was left with a smooth-walled lumen of approximately 9 mm diameter. The tubular blade works very well in separating a thin layer from inside of the fistula models and the cannulated screw is capable of easily removing the separated tissue. The removed tissue could be used as a sample of the whole tract for histopathological examinations. The screw and flexible guidewire lead the blade along the tract in a good manner and ensure circumferential separation of the fistula. With regard to the results of our tests, it is anticipated that the new set is an efficient instrument for easy, safe and fast core-out excision of high anal fistulas and is able to reduce the risk of injuries to healthy tissue encircling the fistulous tract.

Long-Term Outcome of Endorectal Advancement Flap for Complex Anorectal Fistulae

2008 ◽  
Vol 74 (10) ◽  
pp. 921-924 ◽  
Author(s):  
Maher A. Abbas ◽  
Rafael Lemus-Rangel ◽  
Ali Hamadani
Keyword(s):  
Rectovaginal Fistula ◽  
Advancement Flap ◽  
Closure Rate ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Surgical Interventions ◽  
Endorectal Advancement Flap ◽  
Lower Closure

The purpose of this study was to determine the long-term outcome of endorectal advancement flap (ERF) for complex anorectal fistulae. A total of 38 ERF were performed in 36 patients (2003–2007). Mean age was 45 years. The most common fistula type was transsphincteric. Eighty-one per cent of patients had prior surgical interventions. Primary closure rate was 83 per cent. Of the six initial failures, four were noted in patients operated for recurrent rectovaginal fistula. Postoperative complications occurred in seven patients (19%). During a mean follow-up of 27 months, recurrent disease was noted in five patients (14%). All recurrences were noted in patients with left sided fistulae. At last follow-up, all patients had healed their fistula except for two. We conclude that ERF closed most complex anorectal fistulae with an acceptable complication rate and low recurrence rate. Recurrent rectovaginal fistula was associated with a lower closure rate.

scholarly journals Management of Complex Fistula in Ana with Fistulotomy and Stage Procedure

2018 ◽  
Vol 27 (1) ◽  
pp. 83-87
Author(s):  
MNH Masum ◽  
A Yazdani ◽  
M Masum ◽  
MS Biswas ◽  
MA Bhuiyan ◽  
...  
Keyword(s):  
Anal Verge ◽  
Advancement Flap ◽  
Single Stage ◽  
Fistula Tract ◽  
Internal Opening ◽  
Fistula In Ano ◽  
Medical College ◽  
Stool Incontinence ◽  
Complex Fistula

Background: Complex fistula in ano is a troublesome disease and is difficult to treat. Complex fistula in ano occurs in various forms like multiple external and/or internal openings, internal opening above the dentate line, external opening far away from anal verge, anterior tract etc. They are almost invariably recurrent and frequently associated with other systemic diseases like tuberculosis, inflammatory bowel disease, malignancy etc.A complex fistula in ano has various modalities of treatments like application of setons, fistulotomy or fistulectomy, endorectal advancement flap, anocutaneous advancement flap, fistula plug, fibrin glue, electrocauterization of tract/laser and ligation of intersphincteric fistula tract (LIFT). Objective: The purpose of the study is to evaluate the outcome of complex fistula in ano by fistulotomy and staged procedure. Methods: The study was held in Dhaka medical college Hospital and various private hospitals located in Dhaka and Brahmonbaria within duration of 8 years (from January, 2011 to January, 2018). Among 256 patients (221 male, 35 female) with median age 48 years (30 to 72 years) with the diagnosis of complex fistula in ano, 135 underwent fistulotomy with application of Seton with stage procedure. 121 patients underwent single stage fistulotomy. 158 patients had history of previous operations. After stage procedure, regular follow up was done every week until wound healing occurred. Result: Among 256 patients 121 patients (47%) underwent single stage, 133 (52%) patients underwent two stage and 2 patients underwent three stage procedure during the trial period. Majority of the patients had minor incontinence; that is flatus and/or loose stool incontinence. But they only persisted for an average of 10 to 16 days and subsided spontaneously. None of the patient had any major (solid stool) incontinence. 4 patients (2%) had recurrence of fistula on an average of 3-6 months after complete healing. Recurrence occurred in the form of abscess, automatically burst internally, recurrent fistula.2 patients developed bleeding after single stage procedure and was managed by cauterization. Conclusion: With adequate postoperative care and regular follow up, application of Seton with ‘staged procedure’ in cases of complex fistula in ano is very effective and has very minimal complications. Chance of major incontinence and recurrence is also less. J Dhaka Medical College, Vol. 27, No.1, April, 2018, Page 83-87

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