Long-term outcome following advancement flaps for high anal fistulas in an Asian population: a single institution’s experience

Lee, Chin-Li; Lu, Jirong; Lim, Tian-Zhi; Koh, Frederick H.; Lieske, Bettina; Cheong, Wai-Kit; Tan, Ker‐Kan

doi:10.1007/s00384-014-2100-y

Cited by 17 publications

(19 citation statements)

References 23 publications

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“…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.…”

Section: Resultsmentioning

confidence: 99%

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

et al. 2018

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AimThe aim was to compare the effectiveness of the anal fistula plug (AFP) with the rectal advancement flap (RAF) for complex cryptoglandular anal fistulas. MethodsWe conducted a literature search to identify relevant available articles published without language restriction from Embase and PubMed databases and the Cochrane Library. Studies comparing outcomes with the AFP vs RAF for complex cryptoglandular anal fistulas were eligible for inclusion.Results A total of 11 articles with 810 patients were included in this meta-analysis. Four RCTs and one observational clinical study provided long-term followup. The pooled analysis of all 11 studies indicated that there was no significant difference between the AFP and RAF in terms of healing rate, recurrence rate and incidence of fistula complications. However, the pooled results of studies with long-term follow-up revealed that the RAF group had a significantly higher healing rate (OR 0.32, 95% CI 0.13, 0.78, P = 0.01) and lower recurrence rate (OR 4.45, 95% CI 1.45, 13.65, P = 0.009) than the AFP group.Conclusions For the treatment of complex cryptoglandular anal fistulas, the RAF was superior to the AFP in terms of healing and recurrence rate after pooling of randomized controlled trials with long-term follow-up, even though a comparison based on the pooling of all studies showed no significant difference.

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Section: Resultsmentioning

confidence: 99%

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

et al. 2018

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“…1,2 Among this diverse population, there was a recurrence-free rate of 93%, with a median duration of followup of 6 months, making this study one of the largest, most successful and longest that is reported in the literature. 1,2,16 Many studies discuss the limited descriptive data on complex stula populations who undergo EAF. 1,2 At present, there is still no clear de nition of a "typical" patient with this pathology, and it is unclear if the results from this series can be applied to other populations.…”

Section: Discussionmentioning

confidence: 99%

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

Al-Turaihi

Blears

Sugumar

et al. 2020

Preprint

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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.

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“…11,15 It was later modi ed using a ap of rectal tissue to close the tract between the source of the stula deeper in the cryptoglandular tissue and its opening to the anal mucosa. 11,15,16 Flaps can be tongue-shaped, rhomboid, or elliptical and can include the rectal mucosa alone, or extend deeper to include the submucosa, partial layers of the internal anal sphincter or the entire thickness of the internal anal sphincter. 1,2 Traditionally, the opening of the stula within the rectum is either left open to heal by secondary intention or closed with simple, interrupted, or gure-of-eight sutures.…”

Section: Introductionmentioning

confidence: 99%

“…1,2 Traditionally, the opening of the stula within the rectum is either left open to heal by secondary intention or closed with simple, interrupted, or gure-of-eight sutures. 11,15,16 In addition to covering with a ap, the stula tract can be treated with curette or coring out. 1,2 Although technically complex, the advantage of the EAF is that the sphincter complex is left intact, and thus, EAF has a lower risk of fecal incontinence when compared to other surgical options.…”

Section: Introductionmentioning

confidence: 99%

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

Al-Turaihi¹,

Elizabeth

Kavin³

et al. 2020

Preprint

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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 CF 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 statistical significance at alpha of 0.05. Results: With a median follow-up of 6.6 months (range: 3.3-24 months), 99 patients with CFs underwent a modified EAF. Of these, 93% (92/99) had a successful procedure, 7% (7/99) experienced recurrence and 1% (1/99) experienced new-onset 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 recurrence.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 (1%) and a valid treatment option for CFs.

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Long-term outcome following advancement flaps for high anal fistulas in an Asian population: a single institution’s experience

Abstract: Advancement flap procedure is effective in the management of high anal fistulas with an acceptable success rate. The majority of the patients experienced good anal continence.

Cited by 17 publications

References 23 publications

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

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

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

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

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