Lateral mucosal advancement flap: a novel sphincter-preserving technique for the treatment of anal fistula

doi:10.3877/cma.j.issn.2095-3224.2019.05.020

Abstract

Abstract:

Objective

To evaluate the efficacy of lateral mucosal advancement flap for the treatment of anal fistula.

Methods

A total of 28 patients in the Affiliated Hospital of Nanjing University of Chinese Medicine from January 2016 to December 2017 underwent lateral mucosal advancement flap were included in a retrospective study.

Results

16 cases (57.1%) were cryptoglandular anal fistulas and Crohn′s disease was associated in 12 cases (42.9%). The length of follow-up was 10~33 months. Unhealed fistula occurred in 5 patients, giving an overall healing rate of 82.1%. No significant changes in Wexner score were observed (t=0.083, P>0.05). No mucosal flap necrosis and fecal incontinence was occured in the group.

Conclusions

Lateral Mucosal Advancement Flap is an effective and safe technique for anal fistula, especially for anal fistula in Crohn′s disease.

Key words: Rectum, Anal canal, Anal Fistula, Lateral, Mucosal advancement flap

Hao Wang, Yuxia Gong, Minmin Xu, Youran Li, Hongjin Chen, Yunfei Gu. Lateral mucosal advancement flap: a novel sphincter-preserving technique for the treatment of anal fistula[J]. Chinese Journal of Colorectal Diseases(Electronic Edition), 2019, 08(05): 536-540.

/ / Recommend

Add to citation manager EndNote|Ris|BibTeX

URL: https://zhjzcjbdzzz.cma-cmc.com.cn/EN/10.3877/cma.j.issn.2095-3224.2019.05.020

https://zhjzcjbdzzz.cma-cmc.com.cn/EN/Y2019/V08/I05/536

Figures/Tables 2

References 20

[1]	Hall JF, Bordeianou L, Hyman N, et al. Outcomes after operations for anal fistula: results of a prospective, multicenter, regional study[J]. Dis Colon Rectum, 2014, 57(11): 1304-1308.
[2]	Uribe N, Balciscueta Z, Mínguez M, et al. ″Core out″ or ″curettage″in rectal advancement flap for cryptoglandular anal fistula [J]. Int J Colorectal Dis, 2015, 30(5): 613-619.
[3]	Lee CL, Lu J, Lim TZ, et al. Long-term outcome following advancement flaps for high anal fistulas in an Asian population: a single institution′s experience [J]. Int J Colorectal Dis, 2015, 30(3): 409-412.
[4]	van Onkelen RS, Gosselink MP, Thijsse S, et al. Predictors of outcome after transanal advancement flap repair for high transsphincteric fistulas [J]. Dis Colon Rectum, 2014, 57(8): 1007-1011.
[5]	Uribe N, Millán M, Minguez M, et al. Clinical and manometric results of endorectal advancement flaps for complex anal fistula [J]. Int J Colorectal Dis, 2007, 22(3): 259-264.
[6]	Abbas MA, Lemus-Rangel R, Hamadani A. Long-term outcome of endorectal advancement flap for complex anorectal fistulae [J]. Am Surgeon, 2008, 74(10): 921-924.
[7]	Perez F, Arroyo A, Serrano P, et al. Randomized clinical and manometric study of advancement flap versus fistulotomy with sphincter reconstruction in the management of complex fistula-in-ano [J]. Am J Surg, 2006, 192(1): 34-40.
[8]	Jarrar A, Church J. Advancement flap repair: a good option for complex anorectal fistulas [J]. Dis Colon Rectum, 2011, 54(12): 1537-1541.
[9]	Stremitzer S, Riss S, Swoboda P, et al. Repeat endorectal advancement flap after flap breakdown and recurrence of fistula-in-ano-is it an option? [J]. Colorectal Dis, 2012, 14(11): 1389-1893.
[10]	Mitalas LE, Gosselink MP, Zimmerman DD, et al. Repeat transanal advancement flap repair: Impact on the overall healing rate of high transsphincteric fistulas and on fecal continence [J]. Dis Colon Rectum, 2007, 50(10): 1508-1511.
[11]	Boenicke L, Karsten E, Zirngibl H, et al. Advancement flap for treatment of complex cryptoglandular anal fistula: Prediction of therapy success or failure using anamnestic and clinical parameters [J]. World J Surg, 2017, 41(9): 2395-2400.
[12]	Zimmerman DD, Gosselink MP, Mitalas LE, et al. Smoking impairs rectal mucosal bloodflow--a pilot study: possible implications for transanal advancement flap repair [J]. Dis Colon Rectum, 2005, 48(6): 1228-1232.
[13]	Ellis CN, Clark S. Effect of tobacco smoking on advancement flap repair of complex anal fistulas [J]. Dis Colon Rectum, 2007, 50(4): 459-463.
[14]	Zimmerman DD, Delemarre JB, Gosselink MP, et al. Smoking affects the outcome of transanal mucosal advancement flap repair of trans-sphincteric fistulas [J]. Br J Surg, 2003, 90(3): 351-354.
[15]	Mizrahi N, Wexner SD, Zmora O, et al. Endorectal advancement flap: are there predictors of failure? [J]. Dis Colon Rectum, 2002, 45(12): 1616-1621.
[16]	Soltani A, Kaiser AM. Endorectal advancement flap for cryptoglandular or Crohn′s fistula-in-ano [J]. Dis Colon Rectum, 2010, 53(4): 486-495.
[17]	Tan KK, Alsuwaigh R, Tan AM, et al. To LIFT or to flap? Which surgery to perform following seton insertion for high anal fistula? [J]. Dis Colon Rectum, 2012, 55(12): 1273-1277.
[18]	van Koperen PJ, Bemelman WA, Gerhards MF, et al. The anal fistula plug treatment compared with the mucosal advancement flap for cryptoglandular high transsphincteric perianal fistula: a double-blinded multicenter randomized trial [J]. Dis Colon Rectum, 2011, 54(4): 387-393.
[19]	van Koperen PJ, Safiruddin F, Bemelman WA, et al. Outcome of surgical treatment for fistula in ano in Crohn′s disease [J]. Br J Surg, 2009, 96(6): 675-679.
[20]	Ortiz H, Marzo M, de Miguel M, et al. Length of follow-up after fistulotomy and fistulectomy associated with endorectal advancement flap repair for fistula in ano [J]. Br J Surg, 2008, 95(4): 484-487.

项目		例数（%）
性别		?
?	男	23（82.1）
?	女	5（17.9）
年龄（岁，±s）		16~71（35.3±13.1）
瘘管Parks分类		?
?	经括约肌肛瘘	22（78.6）
?	括约肌上肛瘘	6（21.4）
既往肛周手术史		?
?	肛瘘手术	16（57.1）
?	肛周脓肿手术	8（28.6）
?	痔手术	1（3.6）
?	肛裂手术	1（3.6）
合并症		?
?	克罗恩病	12（42.9）
	吸烟	9（32.1）

项目		例数（%）
性别		?
?	男	23（82.1）
?	女	5（17.9）
年龄（岁，±s）		16~71（35.3±13.1）
瘘管Parks分类		?
?	经括约肌肛瘘	22（78.6）
?	括约肌上肛瘘	6（21.4）
既往肛周手术史		?
?	肛瘘手术	16（57.1）
?	肛周脓肿手术	8（28.6）
?	痔手术	1（3.6）
?	肛裂手术	1（3.6）
合并症		?
?	克罗恩病	12（42.9）
	吸烟	9（32.1）

Please choose a citation manager

Content to export