Mucosal advancement flap for recurrent complex anal fistula: a repeatable procedure

• Published in: International journal of colorectal disease Vol. 34; no. 1; pp. 197 - 200
• Main Authors: Podetta, Michele, Scarpa, Cosimo Riccardo, Zufferey, Guillaume, Skala, Karel, Ris, Frederic, Roche, Bruno, Buchs, Nicolas Christian
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01.01.2019; Springer; Springer Nature B.V
• Subjects: Anorectal fistula; Care and treatment; Fistula; Fistulae; Gastroenterology; Hepatology; Internal Medicine; Medicine; Medicine & Public Health; Mucosa; Patients; Proctology; Short Communication; Surgeons; Surgery; Fistula repair; Surgery for anal fistula; Anal fistula; Cryptoglandular fistula; Mucosal advancement flap
• ISSN: 0179-1958; 1432-1262
• DOI: 10.1007/s00384-018-3155-y

Purpose Mucosal advancement flap (MAF) is the best option for complex anal fistula (AF) treatment. Recurrence is not rare and the best surgical option for his handling is a challenge considering the incontinence risk and the healing rate. We aimed to determine the feasibility and outcomes of a second MAF for recurrent complex AF previously treated with mucosal advancement flap. Methods We retrospectively identified 32 patients undergoing two or more MAF for recurrent AF in a larger cohort of 121 consecutive cases of MAF operated by the same senior colorectal surgeon. Only complex AF of cryptoglandular origin was enrolled. A long-term follow-up was performed collecting clinical and functional data. Results Among 121 patients (group A) treated with mucosal advancement flap, 32 (26.4%) (group B) recurred with a complex AF requiring a second mucosal advancement flap procedure. Success rate of group B is 78.1%. Six patients of group B recurred a second time, another MAF was performed with healing in all cases. Complication rate (Clavien Dindo 3b) of group B is 9.4% compared to 8.3% of group A. A slight continence deficit (Miller score 1, 2, and 4) was detected after the first MAF in 3 patients. The Miller score for these patients did not change after the subsequent MAF. Conclusions MAF is effective for treatment of complex recurrent AF. A pre-existing MAF procedure does not worsen the healing rate of the second flap. The rate of surgical complications is similar with those reported in the literature for MAFs.