Identification of epithelialization in high transsphincteric fistulas.
BACKGROUND
At present, transanal advancement flap repair (TAFR) is the treatment of choice for transsphincteric fistulas passing through the upper and middle third of the external anal sphincter. It has been suggested that epithelialization of the fistula tract contributes to the failure of the treatment. The aim of this study was to assess the prevalence of epithelialization of the fistula tract and to study its effect on the outcome of TAFR and TAFR combined with ligation of the intersphincteric fistula tract (LIFT).


METHODS
Forty-four patients with a high transsphincteric fistula of cryptoglandular origin underwent TAFR. Nine of these patients underwent a combined procedure of TAFR with LIFT. In all patients the fistula tract was excised from the external opening up to the outer border of the external anal sphincter. In patients undergoing TAFR combined with LIFT an additional central part of the intersphincteric fistula tract was excised. A total of 53 specimens were submitted. Histopathological examination of the specimens was carried out by a pathologist, blinded for clinical data.


RESULTS
Epithelialization of the distal and intersphincteric fistula tract was observed in only 25 and 22% of fistulas, respectively. There was no difference in outcome between fistulas with or without epithelialization.


CONCLUSIONS
Epithelialization of high transsphincteric fistulas is rare and does not affect the outcome of TAFR and TAFR combined with LIFT.
Division of Colon and Rectal Surgery, Department of Surgery, Erasmus MC, University Medical Center, H 181,'s Gravendijkwal 230, 3015 CE Rotterdam, The Netherlands.
L E
LE
Mitalas
R S
RS
van Onkelen
K
K
Monkhorst
D D
DD
Zimmerman
M P
MP
Gosselink
W R
WR
Schouten
D000328:Adult; D000368:Aged; D017577:Cutaneous Fistula / Q000473:pathology* / Q000601:surgery; D004848:Epithelium / Q000254:growth & development; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D012003:Rectal Fistula / Q000473:pathology* / Q000601:surgery; D013524:Surgical Flaps; D016896:Treatment Outcome; D014945:Wound Healing; D055815:Young Adult