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  • Title: Is the outcome of transanal advancement flap repair affected by the complexity of high transsphincteric fistulas?
    Author: Mitalas LE, Dwarkasing RS, Verhaaren R, Zimmerman DD, Schouten WR.
    Journal: Dis Colon Rectum; 2011 Jul; 54(7):857-62. PubMed ID: 21654253.
    Abstract:
    BACKGROUND: Transanal advancement flap repair for the treatment of high transsphincteric fistulas fails in 1 of every 3 patients. Until now no definite risk factors for failure have been identified. The question is whether the more complex fistulas, such as those with horseshoe extensions and associated abscesses, have a less favorable outcome. OBJECTIVE: Aim of the present study was to indentify whether more complex fistulas have a less favorable outcome. DESIGN: This study is a retrospective case series review. PATIENTS: Between 1995 and 2007 a series of 162 patients underwent endoanal MR imaging before transanal advancement flap repair. Two investigators, without prior knowledge of the surgical findings, reviewed all MR images. RESULTS: Lateral fistulas were identified in 5 patients. Because of the small number, these patients were excluded from further analysis. Posterior fistulas were identified in 119 patients (76%). These fistulas had 3 types of extensions: a direct course (36%), a classic horseshoe extension (23%), or an intersphincteric horseshoe extension (41%). The corresponding healing rates were 37%, 81%, and 73%. Anterior fistulas were observed in 23% of the patients. These fistulas had 2 types of extensions: a direct course (61%) or a classic horseshoe extension (39%). The corresponding healing rates were 60% and 52%. The healing rate of fistulas with a direct course was significantly lower than the healing rate of fistulas with a classic or intersphincteric horseshoe extension. Associated abscesses were found in 47% of the posterior fistulas and 5% of the anterior fistulas. Once adequately drained, these abscesses did not affect the outcome of transanal advancement flap repair. CONCLUSION: The complexity of high transsphincteric fistulas does not affect the outcome of transanal advancement flap repair.
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