title: Long-term results after endoanal advancement flap repair for fistulas-in-ano. How important is the aetiology?
abstract: OBJECTIVE
  The purpose of this study was to assess primary healing, recurrence and continence after endoanal advancement flap repair (EAFR).
  
  
  METHODS
  Seventy-seven patients with fistulas-in-ano of different etiologies received endoanal advancement flap repair between 1997 and 2009. This is a prospective, non-randomized, single-centre, single-surgeon study.
  
  
  RESULTS
  Follow-up data was available for 71 patients. 47.9 % had cryptoglandular fistulas. In 40.8 %, the fistulas were due to chronic inflammatory bowel disease. In 11.3 %, the fistula was a consequence of treatment for cancer. Primary healing was observed in 41 of the cases (57.7 %). The median time to recurrence was 27 months (mean 43.43 ± 48.11) and differed significantly across the patient groups: cryptoglandular origin 51 months (mean 57.09 ± 52.57), condition after cancer treatment 43 months (mean 31 ± 23.142), inflammatory bowel disease 11 months (mean 23.65 ± 32.47) (p < 0.01). Preoperatively, 31 (44.3 %) of the patients had impaired continence vs 30 (42.9 %) postoperatively. Overall, postoperative mean Cleveland Clinic incontinence score values improved significantly (preoperative 3.74 ± 4.558 vs postoperative 2.68 ± 4.752, p = 0.03).
  
  
  CONCLUSIONS
  Full-thickness endoanal advancement flap repair is a successful treatment option for a range of fistula etiologies. Overall, fistula aetiology proved to be prognostically more relevant than fistula location. Fistulas associated with chronic inflammatory bowel disease were found to have a significantly higher rate of recurrence and shorter time to recurrence at long-term follow-up. Repeat interventions do not negatively impact postoperative continence.
authors: Clinic for General and Visceral Surgery, University Hospital Freiburg im Breisgau, Hugstetter Straße 55, 79106, Freiburg im Breisgau, Baden-Württemberg, Germany, matthias.goos@uniklinik-freiburg.de.
authors: Matthias
authors: M
authors: Goos
authors: Ph
authors: P
authors: Manegold
authors: M
authors: M
authors: Grüneberger
authors: O
authors: O
authors: Thomusch
authors: Günther
authors: G
authors: Ruf
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D005242:Fecal Incontinence / Q000209:etiology; D005260:Female; D005401:Fissure in Ano / Q000209:etiology* / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D015212:Inflammatory Bowel Diseases / Q000150:complications; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012008:Recurrence; D013524:Surgical Flaps; D013997:Time Factors; D014945:Wound Healing; D055815:Young Adult
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