Mucosal advancement flap for recurrent complex anal fistula: a repeatable procedure

Podetta, Michele; Scarpa, Cosimo Riccardo; Zufferey, Guillaume; Skala, Karel; Ris, Frédéric; Roche, Bruno; Buchs, Nicolas

doi:10.1007/s00384-018-3155-y

Cited by 20 publications

(26 citation statements)

References 13 publications

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“…This is a comparative study on this subject. In the past, most studies dealt with either only CD patients or only cryptoglandular stulas 7,24,27 .…”

Section: Discussionmentioning

confidence: 99%

“…A variety of treatment options exist, including stulotomy for super cial stula course or seton drainage 4,5 . Fistula closure can also be performed by surgical reconstructive and sphincter preserving methods like mucosal or submucosal rectal advancement ap or LIFT (ligation of intersphinteric stula tract) procedure [6][7][8][9] . The results after LIFT or advanced ap were examined separately in a large review for cryptoglandular and CD stulas with a comparable result 9 .…”

mentioning

confidence: 99%

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Healing of rectal advancement flap for anal fistula in patients with and without Crohn’s disease: a retrospective cohort analysis

Seifarth

Lehmann

Holmer

et al. 2021

Preprint

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Background Surgical closure of anal fistulas with rectal advancement flap is an established standard method, but in some cases, it has a high degree of healing failure. There are few studies in literature with a small number of cases examining differences between patients with and without Crohn's disease (CD). The aim of this study was to identify risk factors for anal fistula healing failure after advancement flap between patients with cryptoglandular fistulas and patients with CD. Methods From January 2010 to October 2020, 155 rectal advancement flaps (CD patients = 55, non-CD patients = 100) were performed. Patients were entered into a prospective database and retrospectively analyzed for healing rates. Results Median follow up was 189 days (95 % CI: 109–269). Overall complication rate was 5.8 %. Total healing rate for all rectal advanced flaps was 56 %. CD patients were younger (33 vs. 43 years, p < 0.001), more often female (76 vs. 30 %, p < 0.001), had more immunosuppressant medication (65 vs. 5 %, p < 0.001), more vaginal fistulas (29 vs. 8 %, p = 0.001) and more protective stomas (49 vs. 2 %, p < 0.001) than patients without CD. However, there was no difference in the healing rate of patients with or without CD (47 % vs. 60 %, p = 0.088). Conclusions Patients with anal fistulas without and with Crohn’s disease have the same healing rate. Although patients with CD differ in their patient-specific characteristics, no independent factors for the occurrence of anal fistula healing failure could be determined. Trial registration: Not applicable due to the retrospective study design.

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“…This is a comparative study on this subject. In the past, most studies dealt with either only CD patients or only cryptoglandular stulas 7,24,27 .…”

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Healing of rectal advancement flap for anal fistula in patients with and without Crohn’s disease: a retrospective cohort analysis

Seifarth

Lehmann

Holmer

et al. 2021

Preprint

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“…Recurrence of the disease in both seton placement and rectal advancement flap methods can be due to the surgeon's inadequate experience and failure to diagnose internal fistula hole, horseshoe fistula, nicotine use by the patient, and a history of chronic constipation. [1415] Moreover, among the reasons for the increased recurrence of anal fistula in the seton placement were the type of seton material, lack of sufficient drainage from the internal fistula hole, and the discharge from the external fistula hole. [15] In contrast to the observed results, in the study of Ege et al (2014), the rate of recurrence of anal fistula disease in seton placement technique was lower than that of rectal advancement flap, which could be due to the difference in the type of seton material.…”

Section: Discussionmentioning

confidence: 99%

“…[1415] Moreover, among the reasons for the increased recurrence of anal fistula in the seton placement were the type of seton material, lack of sufficient drainage from the internal fistula hole, and the discharge from the external fistula hole. [15] In contrast to the observed results, in the study of Ege et al (2014), the rate of recurrence of anal fistula disease in seton placement technique was lower than that of rectal advancement flap, which could be due to the difference in the type of seton material. [16] In addition, in contrast to the results of the present study, van der Hagen et al (2011) reported that the rate of anal fistula recurrence in rectal advancement flap method was higher than the seton placement technique.…”

Section: Discussionmentioning

confidence: 99%

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

Jafarzadeh

Najibpoor

Salmasi

2019

J Family Med Prim Care

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Introduction:Due to the high prevalence of anal fistulas and the recurrence of the disease following surgery, different methods have been suggested for appropriate treatment of this disease. In this study, the effects of rectal advancement flap surgery and seton placement on the recurrence rate, incontinence and wound infection were compared.Methods:In this interventional, prospective and quasi-experimental study, 45 patients with anal fistulas including 28 males and 17 females were studied for 2 years (2015-2017). Patients were divided into two groups and mucosal advancement flap and seton placement techniques were used for each of them. Descriptive analysis of data was performed by SPSS software.Results:24 patients (54%) had seton placement surgery and 21 patients (46%) underwent rectal advancement flap surgery. Recurrence was significantly higher in patients who underwent seton placement surgery than the group that underwent rectal advancement flap surgery. Twelve patients (57%) who underwent rectal advancement flap surgery showed improvement in sphincter tone while 11 patients (45%) showed improvements with seton placement.Conclusion:The overall results of this study showed that rectal advancement flap surgery reduces recurrence and wound infection more significantly than seton placement in patients with anal fistula.

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“…Podetta 18 en 2018, describe el uso colgajo de avance de mucosa posterior a recidiva en pacientes que ya fueron sometidos colgajo previamente. El éxito al primer intento fue un 66,1%, en el grupo con segundo intento 78,1%.…”

Section: Colgajo Endorrectal De Avance (Cera)unclassified

Manejo de la fístula anorrectal compleja. LIFT, colgajo de avance y otras técnicas.

Vallejos

Ocaranza

2020

Rev. Cirugia

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Las fístulas anorrectales complejas son un desafío para el coloproctólogo. Son una patología frecuente que afecta la calidad de vida de los pacientes. La patogénesis aún no esta clara, estarían involucradas citoquinas y el proceso de transición de epitelio a mesénquima. El gold estandar para su estudio es la resonancia nuclear magnética, su uso por si mismo disminuye la recurrencia. El objetivo del tratamiento es lograr la curación sin afectar la función del esfínter evitando las recidivas. Existen múltiples técnicas, siendo la de mayor aceptación la ligadura interesfinteriana del trayecto fistuloso, con tasa de curación sobre el 70%, con mínimo impacto en continencia. Esta revisión incluye otras técnicas como el colgajo endorrectal de avance, uso de sellante, Permacol, células madres, Anal fistula plug, Video asisted anal fistula treatment, Over the scope clip y Fístula laser closure.

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Mucosal advancement flap for recurrent complex anal fistula: a repeatable procedure

Abstract: MAF is effective for treatment of complex recurrent AF. A pre-existing MAF procedure does not worsen the healing rate of the second flap. The rate of surgical complications is similar with those reported in the literature for MAFs.

Cited by 20 publications

References 13 publications

Healing of rectal advancement flap for anal fistula in patients with and without Crohn’s disease: a retrospective cohort analysis

Healing of rectal advancement flap for anal fistula in patients with and without Crohn’s disease: a retrospective cohort analysis

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

Manejo de la fístula anorrectal compleja. LIFT, colgajo de avance y otras técnicas.

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