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Mucosal advancement flap for recurrent complex anal fistula: a repeatable procedure

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A Correction to this article was published on 20 December 2018

This article has been updated

Abstract

Purpose

Mucosal advancement flap (MAF) is the best option for complex anal fistula (AF) treatment. Recurrence is not rare and the best surgical option for his handling is a challenge considering the incontinence risk and the healing rate. We aimed to determine the feasibility and outcomes of a second MAF for recurrent complex AF previously treated with mucosal advancement flap.

Methods

We retrospectively identified 32 patients undergoing two or more MAF for recurrent AF in a larger cohort of 121 consecutive cases of MAF operated by the same senior colorectal surgeon. Only complex AF of cryptoglandular origin was enrolled. A long-term follow-up was performed collecting clinical and functional data.

Results

Among 121 patients (group A) treated with mucosal advancement flap, 32 (26.4%) (group B) recurred with a complex AF requiring a second mucosal advancement flap procedure. Success rate of group B is 78.1%. Six patients of group B recurred a second time, another MAF was performed with healing in all cases. Complication rate (Clavien Dindo 3b) of group B is 9.4% compared to 8.3% of group A. A slight continence deficit (Miller score 1, 2, and 4) was detected after the first MAF in 3 patients. The Miller score for these patients did not change after the subsequent MAF.

Conclusions

MAF is effective for treatment of complex recurrent AF. A pre-existing MAF procedure does not worsen the healing rate of the second flap. The rate of surgical complications is similar with those reported in the literature for MAFs.

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Fig. 1

Change history

  • 20 December 2018

    The name of the second author of this article was incorrectly presented as “Riccardo Scarpa Cosimo” this should have been “Cosimo Riccardo Scarpa”.

References

  1. Steele SR, Kumar R, Feingold DL (2011) Practice parameters for the management of perianal abscess and fistula-in-ano. Dis Colon Rectum 54(12):1465–1474

    Article  PubMed  Google Scholar 

  2. Uribe N, Millán M, Minguez M (2007) Clinical and manometric results of endorectal advancement flaps for complex anal fistula. Int J Color Dis 22(3):259–264

    Article  Google Scholar 

  3. Schouten WR, Zimmerman DD, Briel (1999) Transanal advancement flap repair of transsphincteric fistulas. Dis Colon Rectum 42(11):1419–1422 discussion 1422-3

    Article  CAS  PubMed  Google Scholar 

  4. Ortíz H, Marzo J (2000) Endorectal flap advancement repair and fistulectomy for high trans-sphincteric and suprasphincteric fistulas. Br J Surg 87(12):1680–1683

    Article  PubMed  Google Scholar 

  5. Uribe N, Balciscueta Z, Mínguez M, Martín MC, López M, Mora F, Primo V (2015) “Core out” or “curettage” in rectal advancement flap for cryptoglandular anal fistula. Int J Color Dis 30(5):613–619

    Article  Google Scholar 

  6. Wedell J, Meier zu Eissen P et al (1987) Sliding flap advancement for the treatment of high level fistulae. Br J Surg 74(5):390–391

    Article  CAS  PubMed  Google Scholar 

  7. Mizrahi N, Wexner SD, Zmora O, Silva GD, Efron J, Weiss EG, Vernava AM III, Nogueras JJ (2002) Endorectal advancement flap: are there predictors of failure? Dis Colon Rectum 45(12):1616–1621

    Article  PubMed  Google Scholar 

  8. Ommer A, Wenger FA, Rolfs T, Walz MK (2008) Continence disorders after anal surgery--a relevant problem? Int J Color Dis 23(11):1023–1031

    Article  CAS  Google Scholar 

  9. Mitalas LE, Gosselink MP, Zimmerman DD et al (2007) Repeat transanal advancement flap repair: impact on the overall healing rate of high transsphincteric fistulas and on fecal continence. Dis Colon Rectum 50(10):1508–1511

    Article  PubMed  PubMed Central  Google Scholar 

  10. Miller R, Bartolo DC, Locke-Edmunds JC et al (1988) Prospective study of conservative and operative treatment for faecal incontinence. Br J Surg 75(2):101–105

    Article  CAS  PubMed  Google Scholar 

  11. Christoforidis D, Pieh MC, Madoff RD, Mellgren AF (2009) Treatment of transsphincteric anal fistulas by endorectal advancement flap or collagen fistula plug: a comparative study. Dis Colon Rectum 52(1):18–22

    Article  PubMed  Google Scholar 

  12. Fisher OM, Raptis DA, Vetter D, Novak A, Dindo D, Hahnloser D, Clavien PA, Nocito A (2015) An outcome and cost analysis of anal fistula plug insertion vs endorectal advancement flap for complex anal fistulae. Color Dis 17(7):619–626

    Article  CAS  Google Scholar 

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Author information

Author notes

  1. Michele Podetta and Riccardo Scarpa Cosimo contributed equally to this work.

Authors and Affiliations

  1. Proctology Unit, Service of Visceral Surgery, Geneva University Hospitals and Medical School, Geneva, Switzerland

    Michele Podetta, Cosimo Riccardo Scarpa, Guillaume Zufferey, Karel Skala, Frederic Ris, Bruno Roche & Nicolas Christian Buchs

  2. Département de Chirurgie, Division de Chirurgie Bariatrique, Hôpital du Sacré-Coeur de Montréal, Université de Montréal, Montreal, Quebec, Canada

    Michele Podetta

Authors
  1. Michele Podetta
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  2. Cosimo Riccardo Scarpa
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  3. Guillaume Zufferey
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  4. Karel Skala
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  5. Frederic Ris
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  6. Bruno Roche
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  7. Nicolas Christian Buchs
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Corresponding author

Correspondence to Michele Podetta.

Ethics declarations

For this type of study, formal consent is not required. This article does not contain any studies with animals performed by any of the authors.

Conflict of interest

The authors declare that they have no conflict of interest.

Additional information

The original version of this article was revised: The name of the second author of this article was incorrectly presented as “Riccardo Scarpa Cosimo” this should have been “Cosimo Riccardo Scarpa”.

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Podetta, M., Scarpa, C.R., Zufferey, G. et al. Mucosal advancement flap for recurrent complex anal fistula: a repeatable procedure. Int J Colorectal Dis 34, 197–200 (2019). https://doi.org/10.1007/s00384-018-3155-y

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  • DOI: https://doi.org/10.1007/s00384-018-3155-y

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