Application of Advancement Flap After Loose Seton Placement: A Modified Two-Stage Surgical Repair of a Transsphincteric Anal Fistula

Abstract

PurposeA number of techniques have been described for the treatment of a transsphincteric anal fistula. In this report, we aimed to introduce a relatively new two-stage technique, application of advancement flap after loose seton placement, to present its technical aspects and to document our results.MethodsIncluded in this retrospective study were 13 patients (10 males, 3 females) with a mean age of 42 years who underwent a two-stage seton and advancement flap surgery for transsphincteric anal fistula between June 2008 and June 2013. In the first stage, a loose seton was placed in the fistula tract, and in the second stage, which was performed three months later, the internal and external orifices were closed with advancement flaps.ResultsAll the patients were discharged on the first postoperative day. The mean follow-up period was 34 months. Only one patient reported anal rigidity and intermittent pain, which was eventually resolved with conservative measures. The mean postoperative Wexner incontinence score was 1. No recurrence or complications were observed, and no further surgical intervention was required during follow-up.ConclusionThe two-stage seton and advancement flap technique is very efficient and seems to be a good alternative for the treatment of a transsphincteric anal fistula.

Anal fistula plug vs rectal advancement flap for the treatment of complex cryptoglandular anal fistulas: a systematic review and meta‐analysis of studies with long‐term follow‐up

“…The results are illustrated in Tables and . A total of 39 AFP‐related studies and 43 RAF‐related studies were involved in this analysis. Subsequently, we mapped the healing rate and median follow‐up time of each study into a scatter plot.…”

A comparative study on the effectiveness of rectal advancement flap and seton placement surgeries in patients with anal fistula on the rate of recurrence, incontinence and infection

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Seton drainage in sphincter-sparing treatment of rectal fistulas

“…Сравнительный дизайн встретился также в 3 исследованиях [13,28,31]. В 3 работах давалась четкая характеристика влияния предварительного дренирования свищевого хода лигатурой на результат лечения [7,14,25]. Следует отметить, что в 2 исследованиях [14,25] оценивали влияние дренирующей лигатуры на ис-ход разных вариантов вмешательств (методика LIFT и иссечение свища с низведением лоскута) с анализом преимуществ и недостатков каждой из методик.…”

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