Long‐term functional and clinical outcomes following transanal advancement flap for complex anal fistula repair: are there predictors of recurrence and incontinence?

Uribe, Natalia; Balciscueta, Zutoia; Cuneo, B.; Martín, M. Carmen; Tabet, Janine; López, Manuel

doi:10.1111/codi.15251

Cited by 10 publications

(3 citation statements)

References 20 publications

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“…This skewness can be traced back to our preference for LIFT over transanal advancement flap repair (TAFR) for women with anterior fistulas. With 30 female patients presenting with anterior fistulas (comprising 27% of the cohort), this is in line with other recommendations, aiming for superior results in this particular patient group 20 . The exact influence of this strategy on this study’s outcomes remains undefined but likely reflects prevalent clinical practice.…”

Section: Discussionsupporting

confidence: 87%

Ligation of intersphincteric fistula tract (LIFT) for trans-sphincteric cryptoglandular anal fistula: long-term impact on faecal continence

van Oostendorp,

Verkade,

Han-Geurts

et al. 2024

BJS Open

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Background The ligation of intersphincteric fistula tract is a surgical technique designed to treat trans-sphincteric anal fistulas aiming to preserve sphincter integrity. Recent studies suggest its efficacy in short-term fistula healing with limited impact on continence. However, comprehensive prospective data on long-term outcomes, including recurrence and bowel continence, are limited. The present study aims to report on the long-term functional outcomes. Methods Patients who underwent the ligation of intersphincteric fistula tract procedure for trans-sphincteric cryptoglandular anal fistulas between July 2012 and October 2018 at two Dutch referral centres were retrospectively reviewed. The primary outcome of interest was the long-term bowel continence after the ligation of intersphincteric fistula tract procedure, using the faecal incontinence severity index. Short-term data (collected in 2018) and long-term data (collected in 2023) on bowel continence, healing rates and recurrences were obtained through electronic records and Rockwood questionnaires. Sankey diagrams were used to visually represent individual variations in continence status (preoperative versus follow-up). Results Among 110 patients included (50% female, median follow-up 92 months), 101 patients (92%) were treated with previous surgeries (median 2, range 0–6) and 80% had previous seton drainage. Preligation of intersphincteric fistula tract, 16% of the patients reported incontinence (mean(s.d.) faecal incontinence severity index: 2.4(7.5), increasing to 18% after ligation of intersphincteric fistula tract at short-term follow-up, including 11% newly induced cases. Long-term follow-up collected using Rockwood questionnaires (63% response rate) in 69 patients uncovered a 74% incontinency rate (mean(s.d.) faecal incontinence severity index: 9.22(9.5). In those patients without subsequent surgery 49% (17 of 35) reported incontinence at long-term follow-up. Primary fistula healing after ligation of intersphincteric fistula tract was 28%. Preoperative seton drainage significantly improved healing rates (33% versus 9%). Notably, 43% (34 of 79) of unhealed fistulas transitioned into intersphincteric tracts; in these patients, 19 were treated with subsequent fistulotomy achieving cure in 18 cases. Conclusions Ligation of intersphincteric fistula tract healing rates fell below recent literature standards. Although the immediate impact on postoperative continence appears minimal, long-term incontinence rates are concerning. In recognizing the deterioration of individual continence, we advocate for a patient-centered approach and urge fellow researchers and clinicians to collect comprehensive prospective continence data.

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Section: Discussionsupporting

confidence: 87%

Ligation of intersphincteric fistula tract (LIFT) for trans-sphincteric cryptoglandular anal fistula: long-term impact on faecal continence

van Oostendorp,

Verkade,

Han-Geurts

et al. 2024

BJS Open

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“…Although many surgical methods have been innovated in recent years, treating anal fistula is still a huge challenge. Traditional methods such as direct fistula resection and chronic rubber band resection have a high risk of incontinence in these fistulas ( 12 ). The newer methods are relatively safe but have a low success rate and are a complicated surgical procedure for a junior surgeon ( 13 ).…”

Section: Discussionmentioning

confidence: 99%

Internal Orifice Alloy Closure—A New Procedure to Treat Anal Fistula

Fang

Zhang

et al. 2022

Front. Surg.

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BackgroundThe internal orifice plays an important role in the pathogenesis and treatment of the most complex fistula-in-ano. The treatment of the internal orifice is considered to be the key to the success of anal fistula surgery. The objective of this study is to evaluate the feasibility of a new sphincter-sparing surgical approach for anal fistula.Materials and MethodsAll hospitalized anal fistula patients were included in this study. Preoperative anorectal ultrasound was done on all the patients. Transanal internal orifice alloy closure (IOAC) was performed through a disposable titanium nickel alloy anal fistula stapler. The external sphincter was not cut. An anal fistula brush was used to curette and clean fistulas. Postoperative anorectal color ultrasound was used for evaluation 2 months postoperatively.ResultsTwenty-one patients (male/female: 18/3, age: 39.7 ± 10.5 years) with fistula-in-ano were included (follow-up: 6–11 months).In total, 38.1% (8) had multiple tracts, and 9.5% (2) belonged to a high anal fistula. In total, 23.8% (5) of anal fistula patients were complicated by Crohn’s disease. The fistula healed completely in 85.7% (18/21) and did not heal in 14.3% (3/21). Three patients who did not heal had conventional surgery reperformed and eventually healed. Except for three patients undergoing additional traditional anal fistula surgery, the Wexner incontinence scores of other patients did not change after surgery compared with before surgery.ConclusionsIOAC is a novel sphincter-saving technique that is simply effective in treating anal fistula containing Crohn’s anal fistula.

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“…This technique allows the coverage of the primary opening and healing of approximately 78%–80% of fistulas [1]. Use of a full‐thickness rectal flap has been shown to increase success rates [2–4]. In our institution, the transanal flap is the chosen technique for patients with a cryptoglandular complex perianal fistula.…”

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confidence: 99%