title: Treatment of anal fistulas by partial rectal wall advancement flap or mucosal advancement flap: a prospective randomized study.
abstract: BACKGROUND
  High transphincteric perianal fistula represents a technical challenge for surgical management. We compared the effects of partial rectal wall advancement flap versus the mucosal advancement flap in the treatment of high transphincteric perianal fistula in a randomized study in patients with anal fistula.
  
  
  METHODS
  Consecutive patients treated for transphincteric anal fistula at our institution were evaluated for inclusion. Participants were randomly allocated to receive Group I: Fistulectomy, closure of internal sphincter and rectal advancement flap includes mucosa, submucosa, and circular muscle layer sutured 1 cm below the level of internal opening or Group II: The same as group one but the flap includes only mucosa and submucosa. Study variables included fistula closure rate, continence, morbidity, postoperative pain, hospital stay and quality of life.
  
  
  RESULTS
  Forty patients with high transphincteric perianal fistula were randomized and completed the study. Operative time was 31.6 +/- 6.8 min in group I, and 29.4 +/- 4.7 min in group II (P = 0.783). Hospital stay was significantly more in group 2 (96.35 +/- 9.5 vs. 105.8 +/- 13.23) (P = 0.014) Immediate postoperative complications, occurred in one patients (5%) exposed to disruption in group I and 6 patients (30%) in group II. Recurrence occurred in 2 patients (10%) in the group I and 8 patients (40%) in group II. Two patients (10%) in group I developed incontinence for flatus and no patients in the group II develop such complication.
  
  
  CONCLUSIONS
  Partial thickness advancement flap is better than mucosal advancement flap.
authors.affiliation: General Surgery Department, Colorectal Unit, Mansoura University Hospital, Elgomhoria street, Pox 35111, Mansoura, Egypt. wkhafagy@mans.edu.eg
authors.forename: Wael
authors.initials: W
authors.lastname: Khafagy
authors.forename: Waleed
authors.initials: W
authors.lastname: Omar
authors.forename: Ayman
authors.initials: A
authors.lastname: El Nakeeb
authors.forename: Elyamany
authors.initials: E
authors.lastname: Fouda
authors.forename: Mohamed
authors.initials: M
authors.lastname: Yousef
authors.forename: Mohamed
authors.initials: M
authors.lastname: Farid
mesh_terms: D000328:Adult; D001003:Anal Canal / Q000601:surgery*; D005242:Fecal Incontinence / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007413:Intestinal Mucosa / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012003:Rectal Fistula / Q000150:complications / Q000473:pathology / Q000601:surgery*; D012008:Recurrence; D013524:Surgical Flaps; D013536:Suture Techniques; D016896:Treatment Outcome; D055815:Young Adult