Endorectal flap advancement repair and fistulectomy for high trans-sphincteric and suprasphincteric fistulas

Background: Low-lying trans-sphincteric anal fistulas respond well to simpl e fistulectomy or fistulotomy. However, management of high fistulas has lon g been a serious problem because of the necessity of preserving at least so me of the sphincter mechanism. The clinical results of endorectal flap adva ncement and fistulectomy for complex anal fistulas were assessed. Methods: A total of 103 consecutive patients with high trans-sphincteric (n = 91) and suprasphincteric (n = 12) fistulas undergoing endorectal advance ment flap repair together with core fistulectomy were included in a prospec tive study. Clinical outcome was assessed in terms of continence and recurr ence by an independent observer for a period of 1 year after operation. Results: Successful healing was achieved in 96 patients (93 per cent). Recu rrent fistula occurred in six (7 per cent) of the 91 patients in the trans- sphincteric group and in one of the 12 patients in the suprasphincteric gro up. Continence disturbance was noted in eight patients (8 per cent). Previo us repair and the level of the fistula did not adversely affect the results obtained. Conclusion: Core fistulectomy associated with endorectal advancement flap r epair is a safe and effective technique for any high trans-sphincteric and suprasphincteric fistula, with good results in terms of recurrence and anal continence.