Long-term outcome following mucosal advancement flap for high perianal fistulas and fistulotomy for low perianal fistulas: recurrent perianal fistulas: failure of treatment or recurrent patient disease?
BACKGROUND
In this study, we determined the long-term outcome of perianal fistulas treated with mucosal advancement flap (MF) or fistulotomy (FT).


METHODS
One hundred three patients with perianal fistulas were treated by MF for high fistulas or FT for low fistulas and were retrospectively assessed by case-note review and examined at the out-patient clinic. The localization and time of recurrence of the fistula were recorded.


RESULTS
Forty-one patients [median follow-up of 72 months (range 48-99)] were treated by an MF, and 62 patients [median follow up of 75 months (range 48-99)] were treated by FT. After 12, 48, and 72 months, the fistula had recurred in 9 (22%), 26 (63%), and 26 (63%) patients of the MF group and in 4 (7%), 16 (26%), and 24 (39%) patients of the FT group, respectively. Eighteen (69%) of the recurrences in the MF group and ten (33%) of the FT group occurred within 24 months after surgery (p=0.01). Four (15%) of the recurrences in the MF group and 13 (54%) of the recurrences in the FT group were present in a different localization (p=0.007).


CONCLUSIONS
The success rate of both FT and MF techniques decreases with time. Recurrence appears to be caused by failure of treatment and by recurrent patient disease.
Department of Surgery, Academic Hospital Maastricht, Maastricht, The Netherlands. sjvanderhagen@refaja.nl
S J
SJ
van der Hagen
C G
CG
Baeten
P B
PB
Soeters
W G
WG
van Gemert
D000328:Adult; D000368:Aged; D003424:Crohn Disease / Q000150:complications / Q000601:surgery; D013505:Digestive System Surgical Procedures / Q000379:methods; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007413:Intestinal Mucosa / Q000473:pathology / Q000601:surgery*; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D012003:Rectal Fistula / Q000209:etiology / Q000473:pathology / Q000601:surgery*; D012008:Recurrence; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013524:Surgical Flaps; D013997:Time Factors; D017211:Treatment Failure