title: Endorectal flap advancement repair and fistulectomy for high trans-sphincteric and suprasphincteric fistulas.
abstract: BACKGROUND
  Low-lying trans-sphincteric anal fistulas respond well to simple fistulectomy or fistulotomy. However, management of high fistulas has long been a serious problem because of the necessity of preserving at least some of the sphincter mechanism. The clinical results of endorectal flap advancement and fistulectomy for complex anal fistulas were assessed.
  
  
  METHODS
  A total of 103 consecutive patients with high trans-sphincteric (n = 91) and suprasphincteric (n = 12) fistulas undergoing endorectal advancement flap repair together with core fistulectomy were included in a prospective study. Clinical outcome was assessed in terms of continence and recurrence by an independent observer for a period of 1 year after operation.
  
  
  RESULTS
  Successful healing was achieved in 96 patients (93 per cent). Recurrent fistula occurred in six (7 per cent) of the 91 patients in the trans-sphincteric group and in one of the 12 patients in the suprasphincteric group. Continence disturbance was noted in eight patients (8 per cent). Previous repair and the level of the fistula did not adversely affect the results obtained.
  
  
  CONCLUSIONS
  Core fistulectomy associated with endorectal advancement flap repair is a safe and effective technique for any high trans-sphincteric and suprasphincteric fistula, with good results in terms of recurrence and anal continence.
authors: Department of Surgery, Hospital Virgen del Camino, Universidad Pública de Navarra, Pamplona, Spain.
authors: H
authors: H
authors: Ortíz
authors: J
authors: J
authors: Marzo
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D005242:Fecal Incontinence / Q000209:etiology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012003:Rectal Fistula / Q000601:surgery*; D012008:Recurrence; D013524:Surgical Flaps; D014945:Wound Healing