Anocutaneous advancement flap closure of high anal fistulas

Background: Fistula-in-ano may be treated by closing the internal fistulous opening. An anocutaneous flap was developed to facilitate this closure. Methods: From October 1995 to April 1997, 40 patients with high trans-sphincteric or suprasphincteric anal fistulas were treated. The important components of the procedure are excision of the internal opening, excision or curettage of the tract, closure of the internal opening by an anocutaneous flap, and external drainage. Results: In two patients (5 per cent) the flap separated and the sutured internal opening was exposed. One of the two was healed 4 weeks later. In the remaining 38 patients, complete healing occurred 2-3 weeks after operation. No patient was incontinent of gas or stool. Conclusion: This procedure is technically simple, heals rapidly with minimal scarring, and cures anal fistulas while preserving the anal sphincter.