Island flap anoplasty for treatment of transsphincteric fistula-in-ano.
BACKGROUND
Treatment of fistula-in-ano often replaces one problem, risk of persistent anal sepsis, with another, either incontinence after fistulotomy or mucosal ectropion after rectal flap advancement. A new technique for treatment of transsphincteric fistulas is described that could eliminate risk of both complications.


METHODS
Island flap anoplasty, previously used in management of anal strictures or ectropion, is modified to treat transsphincteric fistulas.


RESULTS
The operation has been performed in 11 patients, 3 of whom had Crohn's disease. Follow-up varied from one to ten months. Early recurrences have occurred in three patients, two with Crohn's disease and one without. Remaining patients have done well.


CONCLUSIONS
This procedure is technically easy to perform and appears to cure transsphincteric fistulas while preserving anal sphincter. In the event of persistence of fistula, other operative options are not eliminated by this procedure. We feel that further experience and longer follow-up is needed to define precise indications for this procedure and to determine if continence is improved more so than with standard fistulotomy.
Del Pino
A
A
Department of Colon & Rectal Surgery, Cook County Hospital, Chicago, Illinois, USA.
Nelson
R L
RL
Pearl
R K
RK
Abcarian
H
H
D006801:Humans; D011183:Postoperative Complications / Q000517:prevention & control*; D012003:Rectal Fistula / Q000601:surgery*; D013524:Surgical Flaps / Q000379:methods*