Rectal Flap Experience in High Transsphincteric Cryptoglandular Anal Fistula

Abstract

Aim: Despite many treatment modalities, anal fistula disease remains an important problem. High recurrence rates have been reported in the surgical treatment of complicated anal fistulas. We hereby present complicated anal fistula patients treated with rectal advancement flaps.

Methods: Patients who underwent rectal advancement flap surgery by a single surgeon between 2009 and 2019 were analyzed in this retrospective cohort study. Demographic data, number of previous operations, recurrence rate and complications were recorded.

Results: Twenty patients (15 males and 5 females) underwent surgery with the rectal advancement flap technique. Nine patients had more than one previous operation. Seton, partial fistulectomy and curettage were the most performed operative techniques in their previous surgeries. The mean follow-up period was 31 months (3-74). Among 13 patients with follow up periods longer than 12 months, 3 patients had recurrences (23%), all of which had been previously operated twice or more. 

Conclusion: Although rectal advancement flap is not the first choice in the treatment of complicated and high transsphincteric fistulas, it still maintains its importance. Experienced surgeons prefer this method due to its sphincter-sparing nature. In our study we detected a recurrence rate of 23% and incontinence rate of 5%, which was thought to be related to previous surgeries.

Keywords

• Complicated anal fistula,Rectal advancement flap

Yüksek transsfinkterik kriptoglandüler anal fistülde rektal flep deneyimi

Öz

Giriş: Birçok tedavi yöntemine rağmen, anal fistül hastalığı önemli bir problemdir. Özellikle komplike anal fistüllerin cerrahi tedavisinde yüksek nüks oranları bildirilmiştir. Bu çalışmada rektal ilerletme flepleri ile tedavi edilen karmaşık anal fistül hastalarını analiz etmek amaçlandı. 

Yöntemler: 2009-2019 yılları arasında tek cerrah tarafından rektal ilerleme flep yapılan hastalar bu retrospektif kohort çalışmada incelendi. Demografik veriler, önceki operasyon sayısı, nüks oranı ve komplikasyonlar kaydedildi.

Bulgular: Yirmi hastaya (15 erkek ve 5 kadın) rektal ilerleme flep tekniği uygulandı. Dokuz hasta önceden birden fazla ameliyat geçirmişti. Hastalara daha önce seton, parsiyel fistülektomi ve küretaj yapılmıştı. Ortalama takip süresi 31 aydı (3-74). 12 aydan daha uzun takip süreleri olan 13 hastanın 3'ünde nüks (%23) saptandı, bunların hepsi daha önce iki kez veya daha fazla ameliyat geçiren hastalardı. 

Sonuç: Rektal ilerletme flebi, komplike ve yüksek transsfinkterik fistüllerin tedavisinde ilk seçenek olarak kullanılmamasına rağmen, önemini korumaktadır. Deneyimli cerrahlar sfinkter koruyucu yapısı nedeniyle bu yöntemi tercih ediyorlar. Çalışmamızda, önceki ameliyatlara bağlı olarak düşünülebilecek %23'lük bir rekürrens oranı ve %5 inkontinans oranı analiz edildi.

Anahtar Kelimeler

• Komplike anal fistül,Rektal ilerletme flebi

Kaynakça

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