Advancement flap procedure in Crohn and non‐Crohn perineal fistulas: a simple surgical approach

Bessi, G.; Siproudhis, L.; l'Héritier, A. Merlini; Wallenhorst, Timothée; Balc’h, Eric Le; Bouguen, Guillaume; Brochard, Charlène

doi:10.1111/codi.14417

Cited by 15 publications

(8 citation statements)

References 18 publications

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“…Lowering the tract is an important strategy in managing high/complex fistulas. Therefore, effective fistula drainage, which may include several interventions, is needed to avoid SST failure, in particular rectal flap advancement [10]. Furthermore, luminal disease was controlled and no patient had active proctitis.…”

Section: Discussionmentioning

confidence: 99%

“…Failure of the procedure (SST or fistulotomy or seton removal) was defined as the occurrence of at least one of the following items: abscess recurrence, purulent discharge from the tract, visible external opening or drainage surgery [10].…”

Section: Methodsmentioning

confidence: 99%

“…Following the initial drainage, the surgical management of perianal fistulizing CD remains complex and debated. Several types of surgeries have been proposed to achieve closure of the fistula, with a focus on sphincter‐sparing techniques (SST), namely rectal advancement flap [10], glue, plug [11], ligation of the intersphincteric fistula tract (LIFT), radiofrequency, laser, cell injection strains [12], seton removal or fistulotomy [13]. However, these techniques are associated with failure and side effects.…”

Section: Introductionmentioning

confidence: 99%

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Combined strategies following surgical drainage for perianal fistulizing Crohn's disease: failure rates and prognostic factors

et al. 2020

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Aim The medico‐surgical strategy for the treatment of perianal fistulizing Crohn's disease (CD) following surgical drainage remains challenging and debated. Our aims were to describe the failure rate of therapeutic interventions after drainage of the fistula tract and determine the factors associated with failure to optimize medico‐surgical strategies. Method All consecutive patients with perianal fistulizing CD who underwent surgical drainage with at least a 12‐week follow‐up were included. Failure was defined as the occurrence of at least one of the following items: abscess recurrence, purulent discharge from the tract, visible external opening and further drainage procedure(s). Results One hundred and sixty‐nine patients were included. The median follow‐up was 4.0 years. The cumulative failure rates were 20%, 30% and 36% at 1, 3 and 5 years, respectively. The cumulative failure rates in patients who had sphincter‐sparing surgeries or seton removal were significantly higher than in those who had a fistulotomy. Anterior fistula [hazard ratio (HR) = 2.52 (1.13–5.61), P = 0.024], supralevator extension [HR = 20.78 (3.38–127.80), P = 0.001] and the absence or discontinuation of immunosuppressants after anal drainage [HR = 3.74 (1.11–12.5), P = 0.032] were significantly associated with failure in the multivariate analysis model. Conclusion Combined strategies for perianal fistulizing CD lead to a failure rate of 36% at 5 years. Where advisable, fistulotomy may be preferred because it has a lower rate of recurrence. The benefits of immunosuppressants require a dedicated prospective randomized trial.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Combined strategies following surgical drainage for perianal fistulizing Crohn's disease: failure rates and prognostic factors

et al. 2020

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“…Obesity was identified as an independent negative predictor of outcome (Table 1) 37,38 but was discredited by three others. 33,36,39 In our opinion, TAFR can be considerably more challenging in obese patients, so there may definitely be a rationale behind this factor. Unfortunately, due to conflicting evidence as well as the difficulty of intervening, this factor does not seem to be a worthwhile modifiable factor.…”

Section: Patient-related Factorsmentioning

confidence: 92%

Transanal Advancement Flap Repair: The Current Gold Standard for Cryptoglandular Transsphincteric Perianal Fistulas

Zimmerman¹,

Stijns²,

Wasowicz³

et al. 2019

tjcd

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Transanal ilerletme flep tekniği, yüz yıldan fazla süredir transsfinkterik perianal fistüller için bir tedavi yöntemi olarak görülmüştür. Çeşitli sistematik derlemeler, bu tekniğin kontinans üzerinde minimal ve öngörülebilir bir etki ile olguların yüzde 80'inde etkili olduğunu göstermiştir. Daha kalın fleplerin kullanımının iyileşme oranını artırdığı, ancak aynı zamanda kontinans bozulma oranını da artırdığı gösterilmiştir. Ne yazık ki, iyileşmeyi etkileyebilecek az sayıda değiştirilebilir faktör vardır. Sigarayı bırakma ve kilo verme bunların arasında sayılabilir. Saptırıcı stomaların kullanımını destekleyen herhangi bir kanıt yoktur. Standart tedavi rejiminin bir parçası olarak setonların yerleştirilmesi literatür tarafından desteklenmemektedir. Flep onarımını diğer tekniklerle birleştirmek tavsiye edilmez.

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“…All these patients were on anti‐tumour necrosis factor alpha therapy. There is now growing evidence that in patients with Crohn's fistulae, it is essential to combine surgery with biologic agents . When managing Crohn's fistulae, combining a surgical procedure, which prevents entry of bacteria to the fistula, with immunotherapy seems to be the logical approach.…”

mentioning

confidence: 99%

Radiofrequency thermocoagulation for high transphincteric fistulae, Merlini l'Héritier et al.

Gosselink

2019

Colorectal Disease

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Advancement flap procedure in Crohn and non‐Crohn perineal fistulas: a simple surgical approach

Abstract: Rectal flap advancement is a satisfactory option for the therapeutic management of anal fistula, including CD populations. Fistula drainage is needed before performing this surgical technique.

Cited by 15 publications

References 18 publications

Combined strategies following surgical drainage for perianal fistulizing Crohn's disease: failure rates and prognostic factors

Combined strategies following surgical drainage for perianal fistulizing Crohn's disease: failure rates and prognostic factors

Transanal Advancement Flap Repair: The Current Gold Standard for Cryptoglandular Transsphincteric Perianal Fistulas

Radiofrequency thermocoagulation for high transphincteric fistulae, Merlini l'Héritier et al.

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