Advancement Flap Repair: A Good Option for Complex Anorectal Fistulas

BACKGROUND: Rectal advancement flap is a popular option for treatment of complex anal fistula. Although early outcomes vary, concerns remain about postoperative continence, long-term healing, and its role in patients with Crohn's disease and anovaginal fistulas. PURPOSE: This study aimed to report long-term outcomes in patients with complex fistula disease. PATIENTS: Patients who were undergoing rectal advancement flap for anal fistula were included in the study. DESIGN: Patients were contacted to determine the status of their fistula disease, their bowel function, and their degree of fecal incontinence. MAIN OUTCOME MEASURES: The main outcomes measured were healing rate and continence. RESULTS: There were 98 patients, 43 men and 55 women, mean age 53 +/- 14 years. Fifty-eight had cryptoglandular fistulas, and 40 (41%) had IBD (33 had Crohn's disease). Seventy-seven of 98 patients had perianal fistulas, and all 77 underwent seton drainage before advancement flap. Twenty-one women had anovaginal fistulas. Average postoperative length of stay was 3 +/- 1 days. There were no mortalities. Follow-up was possible in 75 patients, a mean of 7 +/- 3 years after surgery. Primary healing occurred in 54 (72%) patients. Twenty-one patients (28%) underwent further treatment, and 12 (57%) healed after a second advancement flap. Four more patients healed after more than 2 flaps or fistulotomy leading to an overall healing rate of 70 of 75 (93%). Patients with Crohn's disease had lower healing rates than those with cryptoglandular fistulas (87% vs 98%). Thirty-two patients (43%) had normal fecal continence before flap, and 43 (57%) had normal fecal continence after flap. CONCLUSION: Advancement flap is a good option for patients with complex anal fistulas.