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Rectal Flap Experience in High Transsphincteric Cryptoglandular Anal Fistula

Year 2019, Volume: 3 Issue: 10, 746 - 748, 01.10.2019

Ali Kılıç Sırma Mine Tilev Fatih Başak Abdullah Şişik

https://doi.org/10.28982/josam.636918
Cited By: 1

Abstract

Aim: Despite many treatment modalities, anal fistula disease remains an important problem. High recurrence rates have been reported in the surgical treatment of complicated anal fistulas. We hereby present complicated anal fistula patients treated with rectal advancement flaps.

Methods: Patients who underwent rectal advancement flap surgery by a single surgeon between 2009 and 2019 were analyzed in this retrospective cohort study. Demographic data, number of previous operations, recurrence rate and complications were recorded.

Results: Twenty patients (15 males and 5 females) underwent surgery with the rectal advancement flap technique. Nine patients had more than one previous operation. Seton, partial fistulectomy and curettage were the most performed operative techniques in their previous surgeries. The mean follow-up period was 31 months (3-74). Among 13 patients with follow up periods longer than 12 months, 3 patients had recurrences (23%), all of which had been previously operated twice or more. 

Conclusion: Although rectal advancement flap is not the first choice in the treatment of complicated and high transsphincteric fistulas, it still maintains its importance. Experienced surgeons prefer this method due to its sphincter-sparing nature. In our study we detected a recurrence rate of 23% and incontinence rate of 5%, which was thought to be related to previous surgeries.

Keywords

Complicated anal fistula Rectal advancement flap

References

  • 1. De Parades V, Zeitoun JD, Atienza P. Cryptoglandular anal fistula. Journal of Visceral Surgery. 2010;147.4:e203-e215.
  • 2. Parks A G, Gordon PH, Hardcastle JD. A classification of fistula in ano. Br J Sur. 1976;63:1-12.
  • 3. Khafagy W, Omar W, El Nakeeb A, Fouda E, Yousef M, Farid M. Treatment of anal fistulas by partial rectal wall advancement flap or mucosal advancement flap: a prospective randomized study. International Journal of Surgery. 2010;8(4):321-5.
  • 4.Cirocchi R, Farinella E, La Mura F, Cattorini L. Fibrin glue in the treatment of anal fistula: a systematic review. Ann Surg Innov Res. 2009;3:12-15.
  • 5. Sentovich SM. Fibrin glue for anal fistulas: long-term results. Dis Colon Rectum. 2003 Apr;46(4):498-502.
  • 6. Ritchie RD, Sackier JM, Hodde JP. Incontinence rates after cutting seton treatment for anal fistula. Colorectal Dis. 2009 Jul;11(6):564-71. doi: 10.1111/j.1463-1318.2008.01713.x.
  • 7. Christensen A, Nilas L, Christiansen J. Treatment of transsphincteric anal fistulas by the seton technique. Dis Colon Rectum. 1986 Jul;29(7):454-5.
  • 8. Garcia-Aguilar J, Belmonte C, Wong WD, Goldberg SM, Madoff RD. Anal fistula surgery. Factors associated with recurrence and incontinence. Dis Colon Rectum.1996 Jul;39(7):723-9.
  • 9. Safar B, Jobanputra S, Sands D, Weiss EG, Nogueras JJ, Wexner SD. Anal fistula plug: initial experience and outcomes. Dis Colon Rectum. 2009 Feb;52(2):248-52.
  • 10. Ky AJ, Sylla P, Steinhagen R, Steinhagen E, Khaitov S, Ly EK. Collagen fistula plug for the treatment of anal fistulas. Dis Colon Rectum. 2008 Jun;51(6):838-43.
  • 11. Mennigen R, Laukötter M, Senninger N, Rijcken E. The OTSC(®) proctology clip system for the closure of refractory anal fistulas. Tech Coloproctol. 2015 Apr;19(4):241-6. doi: 10.1007/s10151-015-1284-7.
  • 12. Prosst RL, Herold A, Joos AK, Bussen D, Wehrmann M, Gottwald T, Schurr MO. The anal fistula claw: the OTSC clip for anal fistula closure. Colorectal Dis. 2012 Sep;14(9):1112-7. doi: 10.1111/j.1463-1318.2011.02902.x.
  • 13. Sangwan YP, Rosen L, Riether RD, Stasik JJ, Sheets JA, Khubchandani IT. Is simple fistula-in-ano simple? Dis Colon Rectum. 1994;37(9):885-9.
  • 14. Davies M, Harris D, Lohana P, Chandra Sekaran TV, Morgan AR, Beynon J, et al. The surgical management of fistula-in-ano in a specialist colorectal unit. Int J Colorectal Dis. 2008;23(9):833-8.
  • 15. Noble G. New operation for complete laceration of the perineum designed for the purpose of eliminating danger of infection from the rectum. Trans Am Gynecol Soc. 1902;27:357–63.
  • 16. Balciscueta Z, Uribe N, Balciscueta I, Andreu-Ballester JC, García-Granero E. Rectal advancement flap for the treatment of complex cryptoglandular anal fistulas: a systematic review and meta-analysis. Int J Colorectal Dis. 2017 May;32(5):599-609. doi: 10.1007/s00384-017-2779-7.
  • 17. Akiba RT, Rodrigues FG, da Silva G. Management of Complex Perineal Fistula Disease. Clin Colon Rectal Surg. 2016 Jun;29(2):92-100. doi: 10.1055/s-0036-1580631.
  • 18. Marchesa P, Hull TL, Fazio VW. Advancement sleeve flaps for treatment of severe perianal Crohn’s disease. Br J Surg. 1998;85(12):1695–8.
  • 19. Jorge JM, Wexner SD. Etiology and management of fecal incontinence. Dis Colon Rectum. 1993 Jan;36(1):77-97.

Yüksek transsfinkterik kriptoglandüler anal fistülde rektal flep deneyimi

Year 2019, Volume: 3 Issue: 10, 746 - 748, 01.10.2019

Ali Kılıç Sırma Mine Tilev Fatih Başak Abdullah Şişik

https://doi.org/10.28982/josam.636918
Cited By: 1

Abstract

Giriş: Birçok tedavi yöntemine rağmen, anal fistül hastalığı önemli bir problemdir. Özellikle komplike anal fistüllerin cerrahi tedavisinde yüksek nüks oranları bildirilmiştir. Bu çalışmada rektal ilerletme flepleri ile tedavi edilen karmaşık anal fistül hastalarını analiz etmek amaçlandı. 

Yöntemler: 2009-2019 yılları arasında tek cerrah tarafından rektal ilerleme flep yapılan hastalar bu retrospektif kohort çalışmada incelendi. Demografik veriler, önceki operasyon sayısı, nüks oranı ve komplikasyonlar kaydedildi.

Bulgular: Yirmi hastaya (15 erkek ve 5 kadın) rektal ilerleme flep tekniği uygulandı. Dokuz hasta önceden birden fazla ameliyat geçirmişti. Hastalara daha önce seton, parsiyel fistülektomi ve küretaj yapılmıştı. Ortalama takip süresi 31 aydı (3-74). 12 aydan daha uzun takip süreleri olan 13 hastanın 3'ünde nüks (%23) saptandı, bunların hepsi daha önce iki kez veya daha fazla ameliyat geçiren hastalardı. 

Sonuç: Rektal ilerletme flebi, komplike ve yüksek transsfinkterik fistüllerin tedavisinde ilk seçenek olarak kullanılmamasına rağmen, önemini korumaktadır. Deneyimli cerrahlar sfinkter koruyucu yapısı nedeniyle bu yöntemi tercih ediyorlar. Çalışmamızda, önceki ameliyatlara bağlı olarak düşünülebilecek %23'lük bir rekürrens oranı ve %5 inkontinans oranı analiz edildi.

Keywords

Komplike anal fistül Rektal ilerletme flebi

References

  • 1. De Parades V, Zeitoun JD, Atienza P. Cryptoglandular anal fistula. Journal of Visceral Surgery. 2010;147.4:e203-e215.
  • 2. Parks A G, Gordon PH, Hardcastle JD. A classification of fistula in ano. Br J Sur. 1976;63:1-12.
  • 3. Khafagy W, Omar W, El Nakeeb A, Fouda E, Yousef M, Farid M. Treatment of anal fistulas by partial rectal wall advancement flap or mucosal advancement flap: a prospective randomized study. International Journal of Surgery. 2010;8(4):321-5.
  • 4.Cirocchi R, Farinella E, La Mura F, Cattorini L. Fibrin glue in the treatment of anal fistula: a systematic review. Ann Surg Innov Res. 2009;3:12-15.
  • 5. Sentovich SM. Fibrin glue for anal fistulas: long-term results. Dis Colon Rectum. 2003 Apr;46(4):498-502.
  • 6. Ritchie RD, Sackier JM, Hodde JP. Incontinence rates after cutting seton treatment for anal fistula. Colorectal Dis. 2009 Jul;11(6):564-71. doi: 10.1111/j.1463-1318.2008.01713.x.
  • 7. Christensen A, Nilas L, Christiansen J. Treatment of transsphincteric anal fistulas by the seton technique. Dis Colon Rectum. 1986 Jul;29(7):454-5.
  • 8. Garcia-Aguilar J, Belmonte C, Wong WD, Goldberg SM, Madoff RD. Anal fistula surgery. Factors associated with recurrence and incontinence. Dis Colon Rectum.1996 Jul;39(7):723-9.
  • 9. Safar B, Jobanputra S, Sands D, Weiss EG, Nogueras JJ, Wexner SD. Anal fistula plug: initial experience and outcomes. Dis Colon Rectum. 2009 Feb;52(2):248-52.
  • 10. Ky AJ, Sylla P, Steinhagen R, Steinhagen E, Khaitov S, Ly EK. Collagen fistula plug for the treatment of anal fistulas. Dis Colon Rectum. 2008 Jun;51(6):838-43.
  • 11. Mennigen R, Laukötter M, Senninger N, Rijcken E. The OTSC(®) proctology clip system for the closure of refractory anal fistulas. Tech Coloproctol. 2015 Apr;19(4):241-6. doi: 10.1007/s10151-015-1284-7.
  • 12. Prosst RL, Herold A, Joos AK, Bussen D, Wehrmann M, Gottwald T, Schurr MO. The anal fistula claw: the OTSC clip for anal fistula closure. Colorectal Dis. 2012 Sep;14(9):1112-7. doi: 10.1111/j.1463-1318.2011.02902.x.
  • 13. Sangwan YP, Rosen L, Riether RD, Stasik JJ, Sheets JA, Khubchandani IT. Is simple fistula-in-ano simple? Dis Colon Rectum. 1994;37(9):885-9.
  • 14. Davies M, Harris D, Lohana P, Chandra Sekaran TV, Morgan AR, Beynon J, et al. The surgical management of fistula-in-ano in a specialist colorectal unit. Int J Colorectal Dis. 2008;23(9):833-8.
  • 15. Noble G. New operation for complete laceration of the perineum designed for the purpose of eliminating danger of infection from the rectum. Trans Am Gynecol Soc. 1902;27:357–63.
  • 16. Balciscueta Z, Uribe N, Balciscueta I, Andreu-Ballester JC, García-Granero E. Rectal advancement flap for the treatment of complex cryptoglandular anal fistulas: a systematic review and meta-analysis. Int J Colorectal Dis. 2017 May;32(5):599-609. doi: 10.1007/s00384-017-2779-7.
  • 17. Akiba RT, Rodrigues FG, da Silva G. Management of Complex Perineal Fistula Disease. Clin Colon Rectal Surg. 2016 Jun;29(2):92-100. doi: 10.1055/s-0036-1580631.
  • 18. Marchesa P, Hull TL, Fazio VW. Advancement sleeve flaps for treatment of severe perianal Crohn’s disease. Br J Surg. 1998;85(12):1695–8.
  • 19. Jorge JM, Wexner SD. Etiology and management of fecal incontinence. Dis Colon Rectum. 1993 Jan;36(1):77-97.
There are 19 citations in total.

Details

Primary Language English
Subjects Surgery
Journal Section Research article
Authors

Ali Kılıç 0000-0002-4948-0055

Sırma Mine Tilev 0000-0002-9606-3326

Fatih Başak 0000-0003-1854-7437

Abdullah Şişik 0000-0002-7500-8651

Publication Date October 1, 2019
Published in Issue Year 2019 Volume: 3 Issue: 10

Cite

APA Kılıç, A., Tilev, S. M., Başak, F., Şişik, A. (2019). Rectal Flap Experience in High Transsphincteric Cryptoglandular Anal Fistula. Journal of Surgery and Medicine, 3(10), 746-748. https://doi.org/10.28982/josam.636918
AMA Kılıç A, Tilev SM, Başak F, Şişik A. Rectal Flap Experience in High Transsphincteric Cryptoglandular Anal Fistula. J Surg Med. October 2019;3(10):746-748. doi:10.28982/josam.636918
Chicago Kılıç, Ali, Sırma Mine Tilev, Fatih Başak, and Abdullah Şişik. “Rectal Flap Experience in High Transsphincteric Cryptoglandular Anal Fistula”. Journal of Surgery and Medicine 3, no. 10 (October 2019): 746-48. https://doi.org/10.28982/josam.636918.
EndNote Kılıç A, Tilev SM, Başak F, Şişik A (October 1, 2019) Rectal Flap Experience in High Transsphincteric Cryptoglandular Anal Fistula. Journal of Surgery and Medicine 3 10 746–748.
IEEE A. Kılıç, S. M. Tilev, F. Başak, and A. Şişik, “Rectal Flap Experience in High Transsphincteric Cryptoglandular Anal Fistula”, J Surg Med, vol. 3, no. 10, pp. 746–748, 2019, doi: 10.28982/josam.636918.
ISNAD Kılıç, Ali et al. “Rectal Flap Experience in High Transsphincteric Cryptoglandular Anal Fistula”. Journal of Surgery and Medicine 3/10 (October 2019), 746-748. https://doi.org/10.28982/josam.636918.
JAMA Kılıç A, Tilev SM, Başak F, Şişik A. Rectal Flap Experience in High Transsphincteric Cryptoglandular Anal Fistula. J Surg Med. 2019;3:746–748.
MLA Kılıç, Ali et al. “Rectal Flap Experience in High Transsphincteric Cryptoglandular Anal Fistula”. Journal of Surgery and Medicine, vol. 3, no. 10, 2019, pp. 746-8, doi:10.28982/josam.636918.
Vancouver Kılıç A, Tilev SM, Başak F, Şişik A. Rectal Flap Experience in High Transsphincteric Cryptoglandular Anal Fistula. J Surg Med. 2019;3(10):746-8.

Cited By

Treatment of fistula-in-ano: Outcome comparison between traditional surgery and novel approaches. A retrospective cohort study in a single center
Journal of Surgery and Medicine
Nicolò FABBRİ
https://doi.org/10.28982/josam.684298
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