Advancement sleeve flaps for treatment of severe perianal Crohn's disease

Background Traditionally proctectomy has been the treatment for severe, com plex fistula iri ano from Crohn's disease. However, based on the success of rectal advancement flaps in Crohn's disease, circumferential transanal sle eve advancement flaps (TSAFs) were proposed for this subgroup of patients w ith severe fistula. Methods From 1991 to 1995, 13 patients (12 women) with severe perianal Croh n's disease and multiple fistula tracts underwent a TSAF procedure. Data we re collected retrospectively using a standard data sheet. Results There were no postoperative deaths or major morbidity. One year aft er surgery, the fistula had healed in eight of 13 patients (with three requ iring additional surgery before healing). Of patients in whom the procedure failed, three underwent proctectomy for progression of disease and the oth er two had recurrence of a rectovaginal fistula 6 and 8 months: after surge ry. Of six variables evaluated (previous procedure, steroid use, steroid do sage, associated Crohn's disease, associated procedures and diverting stoma ), only associated procedures were significantly related to a successful ou tcome (P = 0.008). Conclusion Some patients with severe perianal Crohn's fistula and a relativ ely normal rectum can be offered TSAFs. Even with successful outcome in eig ht of 13 patients, this may still be a viable option if the only alternativ e would be total proctocolectomy and a permanent stoma.