High anal fistula: an old disease and a new concept

ABSTRACT

This study has assessed the functional results of rectal advancement flap in association with or without core fistulectomy for complex perianal fistula. It has included sixteen patients [eight males and eight females] with complicated high anal fistula, their ages ranged 18-65 years with a mean age 38 years. The patients were submitted for thorough history, clinical, anal examination and fistulogram. All had documented idiopathic high trans-sphincteric fistula in ano, from which six were recurrent and ten were with primary high anal fistulae. Eight patients were treated with rectal advancement flap and core fistulectomy [group A], while the other eight patients were treated with flap advancement with excision of internal and external ostia, debridement of the fistulas track and closure of the internal ostium [group B]. Type, time and difficulties of the operations were recorded. The results have shown that management of fistula in ano whatever high or low must not left to the end of the operation list and must be done by experienced surgeons in order to decrease the rate of postoperative complications as recurrence of the anal fistula and disturbance of the anal continence. Also, the study has shown that flap advancement technique is considered safe and effective one stage procedure with good functional results and minimal or no disturbance of continence and should be considered for the treatment of high or complex perianal fistulae