Direct appositional (no flap) closure of deep anal fistula

Abstract

Simple appositional closure after core fistulectomy for deep anal fistula seems inferior to methods using flap reinforcement.

Predictive factors for recurrence of cryptoglandular fistulae characterized by preoperative three‐dimensional endoanal ultrasound

“…Another option for patients with a high fistula is complete excision, but in the current study the fistula recurred in 61% of patients, which is high compared with reported rates of 12–41% . The three patients whose internal opening could not be identified during EUA all recurred after fistulectomy.…”

Video-assisted anal fistula treatment (VAAFT): a novel sphincter-saving procedure for treating complex anal fistulas

“…In any event, the procedure leaves more or less extensive perianal skin wounds, which is not the case with VAAFT. Athanasiadis et al [31] using a technique of excision of the internal opening, of the intersphincteric tract and of the entire tract up to the external anal sphincter, with a triple suture line designed to close the internal and the external sphincter has reported a technique more invasive and excisional than VAAFT and other surgeons adopting a similar procedure obtained a 59% healing rate [32]. Sir Alan Parks originally proposed a treatment for high anal fistulas consisting of excision of the internal opening with a portion of internal anal sphincter and the cryptoglandular tissue with enlargement of the external opening and curettage of the tract [8].…”

Randomized clinical trial of local gentamicin–collagen treatment in advancement flap repair for anal fistula

“…To minimize sphincter damage, the use of fistulotomy is now often restricted to subcutaneous and other very low fistulas. Various techniques of fistulectomy and closure of the internal opening have been developed, including endoanal advancement flap repair 1 -3 , anocutaneous advancement or island flap repair 4 -6 and direct closure without a flap 7,8 .…”