Smoking affects the outcome of transanal mucosal advancement flap repair of trans-sphincteric fistulas

Abstract

Cigarette smoking affects the outcome of TAFR in patients with a cryptoglandular perianal fistula.

Randomized clinical trial of local gentamicin–collagen treatment in advancement flap repair for anal fistula

“…Earlier larger studies on endoanal advancement flap repair for anal fistula described low recurrence rates of 1-16 per cent 1 -3 , but in three later studies by Sonoda et al 9 , Mizrahi et al 10 and Zimmerman et al 18 , each of which included around 100 patients, recurrence rates were 36, 40 and 31 per cent respectively. In a smaller previous study that included 42 patients with mostly cryptoglandular, trans-sphincteric fistulas, the rate of nonhealing was 45 per cent 11 .…”

“…In most studies that included both cryptoglandular and Crohn's fistulas, patients with Crohn's disease had higher recurrence rates 2,9,10,19 . Schouten et al 20 found that patients with more than one previous fistula repair had significantly higher recurrence rates than those with one or no previous repair (50 versus 13 per cent respectively), but in a later study by the same group there was no difference 18 . In other studies, in which the proportion of patients with previous repairs varied between 15 and 47 per cent, earlier repair had no impact on the recurrence rate 3,9 -11 .…”

“…The presence or not of Crohn's disease is also a possible explanation for their finding that larger body surface area was associated with a lower recurrence rate. In the study by Zimmerman et al 18 , which did not include patients with Crohn's disease, outcome was not related to either age or BMI. In another series age had no impact on recurrence rate, whereas in the present series the recurrence rate tended to be lower among older patients.…”

“…In other studies, in which the proportion of patients with previous repairs varied between 15 and 47 per cent, earlier repair had no impact on the recurrence rate 3,9 -11 . The use of a draining seton before advancement flap repair resulted in lower recurrence rate in a study by Sonoda et al 9 , whereas Zimmerman et al 18 noted that this practice made no difference. In the present study there was a tendency towards a lower recurrence rate in patients with no previous repair.…”

Imaging techniques and combined medical and surgical treatment of perianal Crohn’s disease

“…In order to avoid this, mucosal advancement flap procedure was introduced in the treatment of recurrent transsphincteric and suprasphincteric cryptogenic perianal fistulas. Although no authors reported success rates exceeding *70 % [80,81], the outcome of this procedure was considered satisfactory until 2011 when Jarrar and Church [82] reported a success rate of 98 % in the treatment of cryptogenic fistulae, performing in some cases two or three mucosal advancement flap operations.…”