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Abstract
Background. Surgical correction of rectovaginal and complicated anal-perineal fistulas has been
associated with high rates of complications and failure of repair.
Methods. This paper reports on 107 patients treated during the past 10 years by endorectal
advancement flap repair. Ninety-two percent of the patients were women with mean age
of 38 years (range, 20 to 71 years). Seventy-one had low rectovaginal, 28 had anterior
anal-perineal, and 8 had posterior anal-perineal fistulas. The causes were obstetric
injury, 48; cryptoglandular abscess-fistula, 31; Crohn's disease, 24; and trauma or
after operation, 4. The technique completely preserves the sphincter muscle, covers
the internal opening of the fistula tract with healthy rectal wall, and provides counter
drainage to aid healing.
Results. No deaths occurred in the series. Persistent or recurrent fistula occurred in 17
patients (16%). Nine patients whose initial operation failed underwent a secondary
successful operation. Continence status was unchanged in 80%, improved in 18%, and
was unknown in two patients who still had intestinal flow diversion. Recurrence of
the fistula did not result in destruction of the sphincter mechanism in those patients
who underwent simultaneous reconstructive operation.
Conclusions. The endorectal advancement flap repair successfully treated 93% of the complicated
anorectal fistulas, avoiding fecal diversion and improving, not injuring, sphincter
function.
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Article info
Footnotes
☆Presented at the Fiftieth Annual Meeting of the Central Surgical Association, Cincinnati, Ohio, March 4–6, 1993.
Identification
Copyright
© 1993 Published by Elsevier Inc.
