Complex anal fistulas: plug or flap?

Abstract

The results of treatment of complex anal fistulas are disappointing. The choice of operation of either a RMAF or a FP did not alter the poor healing rates of about one third of patients in each group.

Adoption and success rates of perineal procedures for fistula‐in‐ano: a systematic review

“…Muhlmann et al . demonstrated that the choice of either ACP and AFP did not alter the poor healing rates of about one‐third of patients in each group. Interestingly while the success rates deteriorated in Asia, Australia and North America they did not do so in Europe.…”

Long‐term results of the cutting seton for high anal fistula

“…59 It is difficult to be sure of the reasons for the much higher healing rates in the early studies, but it may be that these were achieved in patient cohorts with a significant proportion of less complex fistulae. Early studies using biosynthetic material placed in the intersphincteric space do not seem to show improved primary healing rates, 60 but a report describing reinforcing the outer part of the fistula with a biosynthetic fistula 33 42 58 74 88 NR 23-35 procedure dependent 3 2 9 Ellis et al 34 44 14 85 79 100 0 21 0 43 Abbas et al 45 19 53 83 91 8 NR 28 Amin et al 46 18 19 83 94 5 16 0 5 (mucous) Muhlmann et al 47 48 4.5 33 39 16 23 NR Jarrar et al 48 75 (40 IBD) 84 72 93 3 5 2 36 Christoforidis et al 49 plug after LIFT is encouraging, with healing of 95% (20 of the 21) after a median follow-up of 14 (range 12-15) months. 61 A high proportion of papers with LIFT do not report on continence, but where available, incontinence rates of 0 to 25% are found ( Table 5).…”

Endorectal Advancement Flap

“…The most common complication appears to be bleeding. In a case series of 189 patients with mucosal fl aps by Aguilar et al [ 4 ], there were two cases of delayed bleeding; bleeding was also reported in 2 of 43 patients by Christoforidis et al [ 19 ], 1 of 167 patients by Golub et al [ 20 ], 1 of 48 patients by Muhlmann et al [ 12 ], and 1 of 31 patients by Joo et al [ 6 ].…”