title: Long-term outcome following advancement flaps for high anal fistulas in an Asian population: a single institution's experience.
abstract: BACKGROUND
  The management of high anal fistula is often complicated and challenging. In spite of numerous new techniques, the advancement flap technique remained an integral procedure in its management. The purpose of this study was to determine the long-term outcome of advancement flap procedures for high anal fistulas.
  
  
  METHODS
  A retrospective review of patients who have undergone an advancement flap procedure for high anal fistula of cryptoglandular origin from June 2003 to April 2012 was performed. Patients were contacted via telephone to evaluate their continence status using the Wexner score.
  
  
  RESULTS
  Sixty-one patients with a median age of 48 (range, 19-74) years and a median follow-up of 6.5 (range, 1-59) months were evaluated. Fifty-three (86.9 %) patients had successful surgery while 8 (13.1 %) failed the procedure. Four of them underwent subsequent surgery. Of the 53 patients who had a successful procedure, 27 were successfully contacted for a telephone interview. Twenty-one (77.8 %) of them reported a Wexner score of '0'. Two (7.4 %) patients had a Wexner score of <4, another 2 had a score of '4' and '10', while the last 2 patients had a score of >10.
  
  
  CONCLUSIONS
  Advancement flap procedure is effective in the management of high anal fistulas with an acceptable success rate. The majority of the patients experienced good anal continence.
authors.affiliation: Division of Colorectal Surgery, University Surgical Cluster, National University Health System, 1E Kent Ridge Road, 119228, Singapore, Singapore.
authors.forename: Chin-Li
authors.initials: CL
authors.lastname: Lee
authors.forename: Jirong
authors.initials: J
authors.lastname: Lu
authors.forename: Tian-Zhi
authors.initials: TZ
authors.lastname: Lim
authors.forename: Frederick H
authors.initials: FH
authors.lastname: Koh
authors.forename: Bettina
authors.initials: B
authors.lastname: Lieske
authors.forename: Wai-Kit
authors.initials: WK
authors.lastname: Cheong
authors.forename: Ker-Kan
authors.initials: KK
authors.lastname: Tan
mesh_terms: D000328:Adult; D000368:Aged; D044466:Asian People; D005242:Fecal Incontinence / Q000209:etiology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D012003:Rectal Fistula / Q000208:ethnology* / Q000601:surgery*; D012008:Recurrence; D012189:Retrospective Studies; D012846:Singapore; D013524:Surgical Flaps; D016896:Treatment Outcome; D055815:Young Adult