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Advancement flap procedure in Crohn and non‐Crohn perineal fistulas: a simple surgical approach
Author(s) -
Bessi G.,
Siproudhis L.,
Merlini l'Héritier A.,
Wallenhorst T.,
Le Balc'h E.,
Bouguen G.,
Brochard C.
Publication year - 2019
Publication title -
colorectal disease
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.029
H-Index - 89
eISSN - 1463-1318
pISSN - 1462-8910
DOI - 10.1111/codi.14417
Subject(s) - medicine , interquartile range , hazard ratio , surgery , fistula , abscess , confidence interval
Abstract Aim Rectal flap advancement is still a part of therapeutic management of anal fistulas. Data on the outcome of rectal flap advancement in patients with Crohn's disease (CD) is scarce. Our objective was to ascertain rates of failure of rectal flap advancement and to determine predictive factors for failure, with a special focus on CD Method The patients’ details, the characteristics of the fistula and the main clinical and therapeutic events were prospectively assessed among patients who underwent rectal flap advancement. All patients had a partial‐thickness rectal flap advancement. Failure of primary rectal flap advancement was defined as the occurrence of at least one of the following: abscess, discharge, visible external opening, further drainage procedure. The rates of failure of rectal flap and the predictive factors of failure were assessed. Results Eighty‐seven patients (34 patients with CD) were included. The median (interquartile range) follow‐up was 13.3 (3.8–38.1) months. The cumulative failure rates were 15.9% (10.3–23.6), 23.0% (16.0–31.8), 31.6% (22.9–41.8) and 41.3% (30.5–53.0) at 3, 6, 12 and 24 months respectively. These data were comparable in Crohn's patients. Those with a supralevator fistula [hazard ratio 2.53 (1.01–7.71), P = 0.0476] and patients who had fewer than two fistula drainages before rectal flap [hazard ratio 3.19 (1.40–8.23), P = 0.005] were associated with higher rectal flap failure rates. In CD patients, the absence of biological therapy at referral was predictive of failure. Conclusion Rectal flap advancement is a satisfactory option for the therapeutic management of anal fistula, including CD populations. Fistula drainage is needed before performing this surgical technique.