Dermal island-flap anoplasty for transsphincteric fistula-in-ano

PURPOSE: The aim of this study was to assess the treatment failures of isla nd-flap anoplasty for fistula-in-ano, a procedure designed to treat fistula without sphincter division. METHODS: Data concerning all patients having d ermal island-flap anoplasty for the treatment of transsphincteric fistula w ere reviewed. Variables assessed were age, gender, radial fistula location, cause, Crohn's disease, previous fistula operations, other complicating il lnesses, internal sphincter closure, simultaneous use of fibrin adhesive in jection, and use of combined dermal and rectal flap for large fistulas. Pos toperative data collected included persistence of the distal tract, recurre nce of the fistula, and treatment of the recurrence. Recurrence (or persist ence) of the fistula was the dependant variable and each risk factor for re currence was assessed using chi-squared analyses. RESULTS: Seventy-three fl aps were performed in 65 individuals. Recurrence developed 17 times in 13 i ndividuals. Recurrence was more likely to occur in males, patients who have had previous treatment of fistulas, patients with large fistulas requiring combined flaps, and patients who had simultaneous fibrin glue injection. P atients with Crohn's disease and individuals having internal sphincter clos ure had fewer recurrences. Factors reaching statistical significance includ ed closure of the internal sphincter, the use of fibrin glue, and cause of the fistula. CONCLUSION: No specific anatomic or demographic characteristic is sufficiently associated with failure to exclude any patient from the op eration. Closure of the internal sphincter should be done as part of the pr ocedure and fibrin glue injection should not be done simultaneously.