Full-thickness endoanal advancement flap repair (EAFR) in patients with IBD and fistulas-in-ano

Purpose: The purpose of this study was to assess primary healing, recurrence and continence after endoanal advancement flap repair in patients with IBD compared to those with cryptoglandular disorders. Patients and Methods: 71 patients with fistulas-in-ano received endoanal advancement flap repair between 1997 and 2009. This is a prospective, non-randomized, single-centre study. Results: Follow up data was available for 63 patients. In 46% the fistulas were due to chronic inflammatory bowel disease. 54 % had cryptoglandular fistulas. Primary healing was observed in 37 cases (58.7 %). The median time to recurrence was 27 months (mean: 45 ± 50.31) and differed significantly across the patient groups: Inflammatory bowel disease 11 months (mean: 23.65 ± 32.47), cryptoglandular origin 51 months (mean: 63.20 ± 55.84) (P < 0.01). Preoperatively, 31 (49.2 %) of the patients had impaired continence versus 30 (47.6%) postoperatively. In IBD there was no significant difference between pre- and postoperative CCIS values (pre 4.05 ± 4.12 vs 3.61 ± 4.78, P = 0.4) Conclusions: Full-thickness endoanal advancement flap repair is a successful treatment option for IBD patients with transsphincteric fistulas. Fistulas associated with chronic inflammatory bowel disease were found to have a significantly higher rate of recurrence and a shorter time to recurrence at long-term follow-up. Repeat interventions do not negatively impact postoperative continence.