The aim of this study was to evaluate the outcome of patients undergoi
ng endorectal advancement flap repair for perianal Crohn's disease rel
ative to the primary site of intestinal Crohn's disease. From January
1991 to December 1995, 31 consecutive endorectal advancement flap repa
irs were performed in 26 patients. The results relative to surgical ou
tcomes, length of hospitalization, and recurrence were analyzed. The m
ean patient age was 40.2 pears (range, 16-70). Type of fistulas includ
ed: rectovaginal: 20 (64.5%), fistula in ano: 8 (25.8%), rectourethral
: 1 (3.2%) and others: 2 (6.5%). The mean length of follow-up was 17.3
(range 3-60) months. The mean length of hospitalization was 3.7 (rang
e 2-5) days. A temporary diverting stoma was created in 6 patients wit
h a 66.7% (4/6) surgical. success rate. Twenty-one of the 26 patients
had previous procedures consisting of 12 (38.7%) bowel resections, 6 (
19.4%) seton placements, 4 (12.9%) drainages, and 6 (19.4%) diverting
ileostomies. Eleven patients had multiple procedures. Ultimately, fist
ulas were eradicated in 22 (71%) cases, including 15 (75%) of the 20 w
ith rectovaginal fistulas and 7 (63.6%) of the 11 with other fistulas.
There was no mortality; morbidity included a flap retraction in 1 pat
ient, who required antibiotics for 5 days and bleeding in 1 patient, w
ho required reoperation. Success was noted in 2 of 8 (25%) patients wi
th small bowel Crohn's disease as compared to 20 of 23 (87%) patients
without small bowel Crohn's disease (P < 0.05). Endorectal advancement
flap is an effective surgical modality for the treatment of fistulas
due to perianal Crohn's disease but is less apt to succeed in patients
with concominant small bowel Crohn's disease.