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Early outcomes of fluorescence angiography in the setting of endorectal mucosa advancement flaps

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Techniques in Coloproctology Aims and scope Submit manuscript

Abstract

Background

Fistula-in-ano has a reported incidence of 31–34%. Besides fistulotomy, options for fistula repair are seton placement, endorectal advancement flap (ERAF), fibrin sealant, anal fistula plug and ligation of the intersphincteric fistula tract. Despite having a reported success rate as high as 75–98%, ERAF is not without complications, including flap breakdown, recurrence and fecal incontinence. Traditionally, maintaining a broad base to preserve blood supply has been advocated to reduce flap failure. And the aim of the present study was to evaluate outcomes of adult patients who underwent ERAF for complex fistula-in-ano with the use of intraoperative fluorescence angiography (FA) at our institution between July 2014 and July 2016.

Methods

We retrospectively reviewed consecutive cases of complex fistula-in-ano repair with ERAF and FA from a prospectively maintained dataset of adult patients with complex fistula-in-ano. Demographics, intraoperative data and 60-day outcomes were recorded and reviewed.

Results

Six patients [five males and one female with a mean age of 40 years (range 25–46 years)], with a total of seven fistulas, were identified. Six (85.7%) of these patients had undergone prior surgery for fistula-in-ano. No recurrences or complications of any type were noted at 2-week and 8-week follow-up. The majority of patients (71.4%) required flap revision based on intraoperative FA prior to flap fixation.

Conclusions

FA is safe and offers real-time assessment of flap perfusion prior to and after fixation in anal fistula repair. The rate of flap ischemia may be underestimated, and therefore, to improve outcomes in ERAF, intraoperative FA should be included in the surgical armamentarium.

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Authors and Affiliations

  1. Division of Colon and Rectal Surgery, Department of Surgery, Morehouse School of Medicine, 720 Westview Dr., Atlanta, GA, 30310, USA

    J. S. Turner, A. Chase & C. E. Clark

  2. Department of Surgery, Morehouse School of Medicine, Atlanta, GA, USA

    A. Okonkwo

Authors
  1. J. S. Turner
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  2. A. Okonkwo
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  3. A. Chase
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  4. C. E. Clark
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Correspondence to J. S. Turner.

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The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed is studies involving human participation were conducted in accordance with the standards of the institution and approved by the institution’s institutional review board.

Informed consent

As this is a study based on data from a databank, informed consent for patients enrolled is not applicable.

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Turner, J.S., Okonkwo, A., Chase, A. et al. Early outcomes of fluorescence angiography in the setting of endorectal mucosa advancement flaps. Tech Coloproctol 22, 25–30 (2018). https://doi.org/10.1007/s10151-017-1732-7

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  • DOI: https://doi.org/10.1007/s10151-017-1732-7

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