FUNCTIONAL RESULTS AFTER TRANSANAL RECTAL ADVANCEMENT FLAP REPAIR OF TRANSSPHINCTERIC FISTULA

Background Transanal rectal advancement flap repair is an operation to treat trans-sphincteric fistula which leaves the external sphincter m uscle essentially untouched. Anal sphincter function was evaluated pro spectively before and after this procedure. Methods Anorectal manometr y was performed in 24 patients before operation and 3 months after sur gery. A detailed standardized questionnaire an faecal continence was a nswered before surgery, then at 3 and 38 months after surgery. Results No significant differences were seen between mean(s.e.m.) preoperativ e and postoperative values for maximum squeeze pressure (100.0(9.7) ve rsus 118.0(12.7) mmHg), maximum resting pressure (56.6(4.3) versus 52. 8(4.1) mmHg), rectal compliance (4.4(0.6) versus 3.5(0.5) ml/mmHg) or any other parameter of anorectal manometry, The questionnaire revealed the occurrence of minor incontinence in two patients following surger y, which remained unchanged for 4 years. Three other patients had cont inence disturbances 4 years after surgery which were probably unrelate d to the procedure. Conclusion In addition to high success rates, tran sanal rectal advancement flap repair also yields excellent functional results. This procedure should be performed for trans-sphincteric fist ula in place of alternative treatments whenever feasible.