ENDOANAL ADVANCEMENT FLAP REPAIR FOR HIGH-LEVELED ANAL FISTULAE: CLINICAL AND MANOMETRIC RESULTS

Document Type : Original Article

Authors

1 Department of Surgery, National Liver Institute, Menoufeyia University

2 Department of Surgery, National Cancer Institute, Cairo University

3 Radiology National Liver Institute, Menoufeyia University, Egypt

4 Colorectal surgery unit, Mansoura University Hospital, Faculty of Medicine, Mansoura University, Egypt

Abstract

Aim: The aim of this prospective study was to evaluate the functional outcomes after endoanal advancement flap (EAF) in treatment of high leveled anal fistulas. 
Methods: From October 2001 to December 2005, 32 patients with high anal fistulae underwent EAF. They were 26 males and 6 females, with a mean age 37.75 ± 7.2 years. Seven patients had recurrent fistulae and five had minor anal incontinence. All patients underwent coring fistulectomy followed by endoanal advancement flap that was sutured to the anoderm below the level of the internal opening. Patients were followed up for 20.16 ± 5.87 months. Continence was evaluated using a special questionnaire. 
Results: EAF was successful with a complete healing in 24 patients (75%) whereas; the overall recurrence rate was 25% after a second operation. Also, 25 patients (78.3%) experienced improved or unaffected anal continence, whereas, seven patients (21.9%) experienced minor degrees of anal incontinence. Manometrically, all patients showed significant decrease in mean resting pressure (MRP) (P: 0.000) while there was no significant changes in mean squeeze pressure (MSP) (P: 0.069) or in the functional anal canal length (P: 0.753). 
Conclusion: EAF allows the treatment of trans-sphincteric fistulae as well as supra-sphincteric fistulae without sacrificing 
anal sphincter function, which is likely to be superior to alternative procedures even in case of recurrence.

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