Sliding flap advancement for the treatment of high level fistulae

Wedell, J; Eissen, P. Meier zu; Banzhaf, G; Kleine, Lawrence J.

doi:10.1002/bjs.1800740522

Cited by 98 publications

(45 citation statements)

References 5 publications

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“…The MAF is associated with a higher morbidity and significant risk of worsening incontinence (0%-52%) [36][37][38][39] . The AFP is associated with less damage.…”

Section: Discussionmentioning

confidence: 99%

Anal fistula plug vs mucosa advancement flap in complex fistula-in-ano: A meta-analysis

Jin²

2012

WJGS

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AIM:To investigate the efficacy of the anal fistula plug (AFP) compared to the mucosa advancement flap (MAF), considered the best procedure for patients with a complex anal fistula. METHODS:The literature search included PubMed, EMBASE, Cochrane Library and OVID original studies on the topic of AFP compared to MAF for complex fistula-in-ano that had a deadline for publication by April 2011. Randomized controlled trials, controlled clinical trials and prospective cohort studies were included in the review. After information collection, a meta-analysis was performed using data on overall success rates as well as incidence of incontinence and morbidity. The quality of postoperative life was also included with the clinical results. RESULTS:Six studies involving 408 patients (AFP = 167, MAF = 241) were included in the meta-analysis. The differences in the overall success rates and incidence of fistula recurrence were not statistically significant between the AFP and MAF [risk difference (RD) = -0.12, 95%CI: -0.39 -0.14; RD = 0.13; 95%CI: -0.18 -0.43, respectively]. However, for the AFP, the risk of postoperative impaired continence was lower (RD = -0.08, 95%CI: -0.15 --0.02) as was the incidence of other complications (RD = -0.06, 95%CI: -0.11 --0.00). The postoperative quality of life, for patients treated using the AFP was superior to that of the MAF patients. Patients treated with the AFP had less persistent pain of a shorter duration and the healing time of the fistula and hospital stay were also reduced. CONCLUSION:The AFP is an effective procedure for patients with a complex anal fistula; it has the same success rate but a lower risk of complications than the MAF and may also be associated with an improved postoperative quality of life. Additional evidence is needed to confirm these findings.

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“…The MAF is associated with a higher morbidity and significant risk of worsening incontinence (0%-52%) [36][37][38][39] . The AFP is associated with less damage.…”

Section: Discussionmentioning

confidence: 99%

Anal fistula plug vs mucosa advancement flap in complex fistula-in-ano: A meta-analysis

Jin²

2012

WJGS

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“…Various techniques have been described including fistulotomy [1][2][3][4], fistulectomy [5] and advancement flap procedures [6][7][8][9][10][11]. The results of fibrin glue treatment have been disappointing and the technique has largely been abandoned [12].…”

Section: Introductionmentioning

confidence: 99%

Incontinence rates after cutting seton treatment for anal fistula

2009

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Objective To determine the incidence of anal incontinence after the use of cutting seton treatment for anal fistula.Method Literature searches were performed on PubMed, MEDLINE and Google Ô Scholar using the words 'cutting seton(s)', 'seton(s)' and 'anal fistula'. An analysis of the data in the collected references was performed.Results The average rate of incontinence following cutting seton use was 12%. The rate of incontinence increased as the location of the internal opening of the fistula moved more proximally. In the studies that described the types of incontinence, liquid stool was the most common followed closely by flatus incontinence. Incontinence associated with the treatment of fistulas defined as nonspecific cryptoglandular in nature was 18%.Conclusion The high incontinence rates that result from the use of cutting setons suggest that this commonly used therapy can damage the continence musculature. Other techniques that do not involve cutting the sphincter, when available, should be preferred, especially for higher fistulas.

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“…In contrast, Jones et al [9] describe a technique which is similar in principle to ours for high transsphincteric and suprasphincteric anal fistulae, in which the tract is cored out and the internal opening of the fistula is excised and then a rectal advancement flap is raised to cover the created raw area. Wedell et al [10] confirmed the efficacy of a similar technique for the treatment of high-level fistulae. The external wound is left open for drainage.…”

Section: Discussionmentioning

confidence: 88%

Jeddah Experience in the Management of High Anal Fistula

Jamjoom

Jamal

1991

Ann Saudi Med

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Twenty-six (26) transsphincteric anal fistulae with secondary high extensions and sixteen (16) suprasphincteric anal fistulae with secondary high extensions have been treated successfully over a period of 3 years. The operative technique depends on exploration of the intersphincteric plane with removal of the primary source of the infection, together with excision of the primary tract, and drainage of the secondary high extensions. The patients have been followed for 2 years without recurrence. Continence for flatus and liquid feces was 92.1% and 96.15%, respectively, in the transsphincteric and 75% and 93.75%, respectively, in the suprasphincteric group but the continence for solid feces was 100% in both. Thus, the so-called excision technique for treatment of high fistula is safe and results are excellent. To lay open a fistula without exact identification of the primary tract and its relation to the sphincteric muscles, is a dangerous procedure [4], as the laying open of transsphincteric running tract can lead to impaired continence particularly in elderly people who have weaker sphincters [5]. High fistula-in-ano is a real problem of considerable surgical importance. We have a large number of recurrent cases with persistent pain, recurrent abscesses, and distress related to being unclean for prayer referred to us. This paper describes our operative technique and reports our results. 1986 and 1989, 42 patients with high fistula-in-ano were treated at King Fahd Hospital and Al Shaty Hospital in Jeddah. The median age was 42 years (range 26 to 56). Twenty-six (23 males and 3 females) had transsphincteric and 16 (14 males and 2 females) suprasphincteric fistulae, both associated with high secondary extensions penetrating the levator plate. All 42 patients had undergone previous surgery an average of 6 times for the transsphincteric group and 8 times for the suprasphincteric group. Material and Methods Between

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Sliding flap advancement for the treatment of high level fistulae

Cited by 98 publications

References 5 publications

Anal fistula plug vs mucosa advancement flap in complex fistula-in-ano: A meta-analysis

Anal fistula plug vs mucosa advancement flap in complex fistula-in-ano: A meta-analysis

Incontinence rates after cutting seton treatment for anal fistula

Jeddah Experience in the Management of High Anal Fistula

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