title: Application of advancement flap after loose seton placement: a modified two-stage surgical repair of a transsphincteric anal fistula.
abstract: OBJECTIVE
  A number of techniques have been described for the treatment of a transsphincteric anal fistula. In this report, we aimed to introduce a relatively new two-stage technique, application of advancement flap after loose seton placement, to present its technical aspects and to document our results.
  
  
  METHODS
  Included in this retrospective study were 13 patients (10 males, 3 females) with a mean age of 42 years who underwent a two-stage seton and advancement flap surgery for transsphincteric anal fistula between June 2008 and June 2013. In the first stage, a loose seton was placed in the fistula tract, and in the second stage, which was performed three months later, the internal and external orifices were closed with advancement flaps.
  
  
  RESULTS
  All the patients were discharged on the first postoperative day. The mean follow-up period was 34 months. Only one patient reported anal rigidity and intermittent pain, which was eventually resolved with conservative measures. The mean postoperative Wexner incontinence score was 1. No recurrence or complications were observed, and no further surgical intervention was required during follow-up.
  
  
  CONCLUSIONS
  The two-stage seton and advancement flap technique is very efficient and seems to be a good alternative for the treatment of a transsphincteric anal fistula.
authors.affiliation: General Surgery Clinic, Kozyatagi Acibadem Hospital, Istanbul, Turkey. ; Department of General Surgery, Istanbul University, Cerrahpasa Medical School, Istanbul, Turkey.
authors.forename: Metin
authors.initials: M
authors.lastname: Ertem
authors.affiliation: General Surgery Clinic, Kozyatagi Acibadem Hospital, Istanbul, Turkey.
authors.forename: Hakan
authors.initials: H
authors.lastname: Gok
authors.affiliation: General Surgery Clinic, Kozyatagi Acibadem Hospital, Istanbul, Turkey.
authors.forename: Emel
authors.initials: E
authors.lastname: Ozveri
authors.affiliation: General Surgery Clinic, Kozyatagi Acibadem Hospital, Istanbul, Turkey.
authors.forename: Volkan
authors.initials: V
authors.lastname: Ozben
keywords: Anal fistula; Flap; Seton; Surgery