Anocutaneous advancement flap closure of high anal fistulas

ABSTRACT

Eighteen patients presented by anal fistulas [15 high trans- sphincteric and three suprasphincteric] underwent anocutaneous advancement flap after excision of the internal opening, excision of the tract and closure of the internal opening at Surgical Department in Ain-Shams University Hospitals. The external component of the fistulous tract was excised and drained externally. The mean follow up period was 14 months. All cases had no any gas or stool incontinence. Complete healing was achieved in 12 patients 3-4 weeks after operation. Minor technical problems were noticed in three patients [flap hematoma in two patients and flap tip breakdown in one patient], such complications did not end with fistula. In the last three patients, recurrence of the fistula happened. In the first patients, recurrence was due to the failure of the flap; whereas in the other two patients, recurrence occurred after evacuation of perianal abscess. Those patients eventually had a low anal fistula and excisional surgery was performed without difficulty. Anocutaneous advancement flap is technically simple, heals rapidly with minimal scaring and cures anal fistulas while preserving the anal sphincter