Long-term analysis of the use of transanal rectal advancement flaps for complicated anorectal/vaginal fistulas

Özüner, Gökhan; Hull, Tracy L.; Cartmill, John; Fazio, Victor W.

doi:10.1007/bf02048261

Cited by 239 publications

(161 citation statements)

References 19 publications

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“…If the rectal mucosa is normal, ERAF can be used in Crohn fistulas as well. 31 A dermal island flap anoplasty (DIFA) is a procedure for resurfacing the anal canal in low anal strictures. Nelson and colleagues modified the procedure to cover the primary opening of the fistula after it was closed with absorbable sutures.…”

Section: Fistulotomy With Sphincterotomymentioning

confidence: 99%

Anorectal Infection: Abscess-Fistula

Abcarian

2011

Clinics in Colon and Rectal Surgery

174

133

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Anorectal abscess and fistula are among the most common diseases encountered in adults. Abscess and fistula should be considered the acute and chronic phase of the same anorectal infection. Abscesses are thought to begin as an infection in the anal glands spreading into adjacent spaces and resulting in fistulas in 40% of cases. The treatment of an anorectal abscess is early, adequate, dependent drainage. The treatment of a fistula, although surgical in all cases, is more complex due to the possibility of fecal incontinence as a result of sphincterotomy. Primary fistulotomy and cutting setons have the same incidence of fecal incontinence depending on the complexity of the fistula. So even though the aim of a surgical procedure is to cure a fistula, conservative management short of major sphincterotomy is warranted to preserve fecal incontinence. However, trading radical surgery for conservative (nonsphincter cutting) procedures such as a draining seton, fibrin sealant, anal fistula plug, endorectal advancement flap, dermal island flap, anoplasty, and LIFT (ligation of intersphincteric fistula tract) procedure all result in more recurrence/persistence requiring repeated operations in many cases. A surgeon dealing with fistulas on a regular basis must tailor various operations to the needs of the patient depending on the complexity of the fistula encountered. KEYWORDS: Fistula, abscess, anorectal infection, sphincterotomy, fecal incontinenceObjectives: At the completion of this article, the reader is expected to understand the etiology and pathogenesis of an anal abscessfistula, the classification of anal fistulas, and alternative surgical procedures.Anorectal abscess-fistula is one of our most common afflictions. Because of the close association of abscess and fistula in etiology, anatomy, pathophysiology, therapy and morbidity, it is appropriate to consider both entities as one, i.e., abscess-fistula or a fistulous abscess. It is also appropriate to consider an abscess as the acute and a fistula as the chronic state of anorectal suppuration. EPIDEMIOLOGY IncidenceMost publications on the subject reflect authors' experience from a single institution; this does not address the incidence of the disease due to lack of a proper denominator. Also, it is difficult if not impossible to accurately access the incidence of anorectal abscesses because they

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Section: Fistulotomy With Sphincterotomymentioning

confidence: 99%

Anorectal Infection: Abscess-Fistula

Abcarian

2011

Clinics in Colon and Rectal Surgery

174

133

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“…Various techniques have been described including fistulotomy [1][2][3][4], fistulectomy [5] and advancement flap procedures [6][7][8][9][10][11]. The results of fibrin glue treatment have been disappointing and the technique has largely been abandoned [12].…”

Section: Introductionmentioning

confidence: 99%

Incontinence rates after cutting seton treatment for anal fistula

2009

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Objective To determine the incidence of anal incontinence after the use of cutting seton treatment for anal fistula.Method Literature searches were performed on PubMed, MEDLINE and Google Ô Scholar using the words 'cutting seton(s)', 'seton(s)' and 'anal fistula'. An analysis of the data in the collected references was performed.Results The average rate of incontinence following cutting seton use was 12%. The rate of incontinence increased as the location of the internal opening of the fistula moved more proximally. In the studies that described the types of incontinence, liquid stool was the most common followed closely by flatus incontinence. Incontinence associated with the treatment of fistulas defined as nonspecific cryptoglandular in nature was 18%.Conclusion The high incontinence rates that result from the use of cutting setons suggest that this commonly used therapy can damage the continence musculature. Other techniques that do not involve cutting the sphincter, when available, should be preferred, especially for higher fistulas.

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“…A summary of study characteristics is shown in Table 1, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31, 32, 33, 34, 35, 36, 37, 38, 39, 40, 41, 42, 43, 44, 45, 46, 47, 48, 49, 50, 51, 52, 53, 54, 55, 56, 57, 58, 59, 60, 61, 62, 63, 64, 65, 66, 67, 68, 69, 70, 71, 72, 73, 74, 75.…”

Section: Resultsmentioning

confidence: 99%

“…Eight retrospective30 37, 39 40, 42, 43, 44 46 and two prospective observational38 41 studies reported the outcome of mucosal advancement flaps in both Crohn's and cryptoglandular perianal fistulous disease. Of the 590 reported procedures, 204 were performed for Crohn's fistula.…”

Section: Resultsmentioning

confidence: 99%

Systematic review of surgical interventions for Crohn's anal fistula

Lee

Heywood²,

Adegbola

et al. 2017

BJS Open

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BackgroundAnal fistula occurs in approximately one in three patients with Crohn's disease and is typically managed through a multimodal approach. The optimal surgical therapy is not yet clear. The aim of this systematic review was to identify and assess the literature on surgical treatments of Crohn's anal fistula.MethodsA systematic review was conducted that analysed studies relating to surgical treatment of Crohn's anal fistula published on MEDLINE, Embase and Cochrane databases between January 1995 and March 2016. Studies reporting specific outcomes of patients treated for Crohn's anal fistula were included. The primary outcome was fistula healing rate. Bias was assessed using the Cochrane ROBINS‐I and ROB tool as appropriate.ResultsA total of 1628 citations were reviewed. Sixty‐three studies comprising 1584 patients were ultimately selected in the analyses. There was extensive reporting on the use of setons, advancement flaps and fistula plugs. Randomized trials were available only for stem cells and fistula plugs. There was inconsistency in outcome measures across studies, and a high degree of bias was noted.ConclusionData describing surgical intervention for Crohn's anal fistula are heterogeneous with a high degree of bias. There is a clear need for standardization of outcomes and description of study cohorts for better understanding of treatment options.

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Long-term analysis of the use of transanal rectal advancement flaps for complicated anorectal/vaginal fistulas

Abstract: TRAF is a safe technique for managing complicated anorectal and rectovaginal fistulas, including patients with Crohn's disease. Long-term follow-up is essential to accurately report recurrence rates.

Cited by 239 publications

References 19 publications

Anorectal Infection: Abscess-Fistula

Anorectal Infection: Abscess-Fistula

Incontinence rates after cutting seton treatment for anal fistula

Systematic review of surgical interventions for Crohn's anal fistula

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