[Surgical treatment of high anorectal and rectovaginal fistulas with the use of transanal endorectal advancement flaps].
BACKGROUND
Sphincterotomy can be avoided in the repair of high anorectal or rectovaginal fistulas by use of rectal advancement flaps.


METHODS
Between 1986 and 1998, 22 patients with high anorectal and 15 patients with rectovaginal fistulas underwent fistulectomy without sphincterotomy and consecutive transanal rectal advancement flap repair.


RESULTS
Primary healing was achieved in 81% (30/37 patients). There was no disturbance of continence though anal resting pressures decreased postoperatively. Recurrences occurred in 4 of 12 patients with Crohn's disease (2 anorectal, 2 rectovaginal) and in 1 patient with traumatic anorectal fistula. There were no recurrences in patients with cryptoglandular disease, while the operation failed in 2 patients with ergotamine-induced fistulas.


CONCLUSIONS
This operative approach achieves a high primary healing rate with optimal functional outcome. Despite good results the indication should be set carefully in patients with Crohn's disease.
Willis
S
S
Chirurgische Universitätsklinik und Poliklinik, RWTH Aachen. swillis@post.klinikum.rwth-aachen.de
Rau
M
M
Schumpelick
V
V
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001720:Birth Injuries / Q000150:complications; D003424:Crohn Disease / Q000150:complications; D004878:Ergotamine / Q000009:adverse effects; D005260:Female; D006801:Humans; D007049:Iatrogenic Disease; D008297:Male; D008365:Manometry; D008875:Middle Aged; D012003:Rectal Fistula / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*; D012006:Rectovaginal Fistula / Q000139:chemically induced / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*; D012008:Recurrence; D019966:Substance-Related Disorders / Q000150:complications; D013524:Surgical Flaps
D004878:Ergotamine