Transanal advancement flap repair of transsphincteric fistulas

Schouten, W. R.; Zimmerman, D. D. E.; Briel, J. W.

doi:10.1007/bf02235039

Cited by 242 publications

(199 citation statements)

References 13 publications

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“…For example, cutting seton has a recurrence rate of 0%-28%, 12,13 and an incontinence rate of 20%-77%, 12,14 while the 'sphincter sparing' advancement flap technique has a recurrence rate of between 25% and 65% and an incontinence rate of 30%. 15 The Surgisis Biodesign Fistula Plug (Cook Medical, Bloomington, IN, USA) is associated with recurrence rates of between 17% and 86% and an incontinence rate of approaching zero, 16,17 while the ligation of fistula track procedure has yielded recurrence rates of 5%-60% and a incontinence rate of 6%. 18 The data in this study were collected prospectively.…”

Section: Discussionmentioning

confidence: 99%

Quality of life with anal fistula

Owen

Buchanan

Schizas

et al. 2016

annals

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INTRODUCTION Anal fistula affects people of working age. Symptoms include abscess, pain, discharge of pus and blood. Treatment of this benign disease can affect faecal continence, which may, in turn, impair quality of life (QOL). We assessed the QOL of patients with cryptoglandular anal fistula. METHODS Newly referred patients with anal fistula completed the St Mark's Incontinence Score, which ranges from 0 (perfect continence) to 24 (totally incontinent), and Short form 36 (SF-36) questionnaire at two institutions with an interest in anal fistula. The data were examined to identify factors affecting QOL. RESULTS Data were available for 146 patients (47 women), with a median age of 44 years (range 18-82 years) and a median continence score of 0 (range 0-23). Versus population norms, patients had an overall reduction in QOL. While those with recurrent disease had no difference on continence scores, QOL was worse on two of eight SF-36 domains (p<0.05). Patients with secondary extensions had reduced QOL in two domains (p<0.05), while urgency was associated with reduced QOL on five domains (p<0.05). Patients with loose seton had the same QOL as those without seton. No difference in urgency was found between patients with and without loose seton. In primary fistula patients, 19.4% of patients experienced urgency versus 36.3% of those with recurrent fistulas. CONCLUSIONS Patients with anal fistula had a reduced QOL, which was worse in those with recurrent disease, secondary extensions and urgency. Loose seton had no impact on QOL.

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Section: Discussionmentioning

confidence: 99%

Quality of life with anal fistula

Owen

Buchanan

Schizas

et al. 2016

annals

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“…The mucosa advancement flap (MAF), recently considered the best available treatment option for complex fistulas, results in a success rate of about 60% [5,6] . This procedure is technically demanding and may affect continence [7] . Use of fibrin glue is an alternative to the MAF; however, the long-term closure rates are low [8][9][10][11][12] .…”

Section: Introductionmentioning

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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“…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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Transanal advancement flap repair of transsphincteric fistulas

Cited by 242 publications

References 13 publications

Quality of life with anal fistula

Quality of life with anal fistula

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

Incontinence rates after cutting seton treatment for anal fistula

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