title: Stapled endorectal mucosectomy for high extrasphincteric fistula-in-ano: preliminary report.
abstract: OBJECTIVE
  There is no optimum surgical method of repair for high extrasphincteric fistula-in-ano. We describe a relatively simple procedure for surgery of extrasphincteric fistula, which entirely preserves the anal sphincter, does not interfere with anal function, and does not preclude the possibility of further surgery, if necessary.
  
  
  METHODS
  Five patients have been treated for high extrasphincteric fistula with a stapled endorectal flap by using a circular hemorrhoidal stapler gun. The procedure involved two 180 degrees pursestrings placed above the dentate line and 3 cm apart, proximal and distal to the internal opening. On firing, the result was the excision of a 180 degrees rectal flap, containing the internal ostium, and including rectal mucosa and submucosa.
  
  
  RESULTS
  No perioperative complications were encountered. There was some temporary difficulty in controlling flatus and/or defecatory urgency in two patients, which spontaneously reversed with no treatment within the first two postoperative months. The mean Cleveland Clinic Score of Incontinence did not vary significantly after surgery. Overall anal manometry did not register any significant differences between preoperative and postoperative values. With up to 26 months of follow-up, none of the fistulas recurred.
  
  
  CONCLUSIONS
  These preliminary promising results suggest that the stapled endorectal flap could have a role in the management of high extrasphincteric fistula-in-ano.
authors.affiliation: Coloproctology Unit, Department of Surgery, University Hospital of Elche, Elche, Spain. faperez@vodafone.es
authors.forename: Francisco
authors.initials: F
authors.lastname: Perez
authors.forename: Antonio
authors.initials: A
authors.lastname: Arroyo
authors.forename: Fernando
authors.initials: F
authors.lastname: Candela
authors.forename: Rafael
authors.initials: R
authors.lastname: Calpena
mesh_terms: D000328:Adult; D001003:Anal Canal / Q000503:physiopathology; D005260:Female; D005401:Fissure in Ano / Q000473:pathology / Q000601:surgery*; D005500:Follow-Up Studies; D006801:Humans; D007413:Intestinal Mucosa / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D020127:Recovery of Function / Q000502:physiology; D012189:Retrospective Studies; D017792:Surgical Stapling / Q000379:methods*; D016896:Treatment Outcome