Endorectal Advancement Flap for Cryptoglandular or Crohn's Fistula-in-Ano

被引:243
作者
Soltani, Ali [1 ]
Kaiser, Andreas M. [1 ]
机构
[1] Univ So Calif, Keck Sch Med, Dept Colorectal Surg, Los Angeles, CA 90033 USA
关键词
Fistula; Advancement flap; Perianal Crohn disease; Systematic reviews; COMPLEX ANAL FISTULAS; MUCOSAL ADVANCEMENT; TRANSSPHINCTERIC FISTULAS; ANORECTAL FISTULAS; FIBRIN GLUE; PERIANAL FISTULAS; FOLLOW-UP; REPAIR; MANAGEMENT; DISEASE;
D O I
10.1007/DCR.0b013e3181ce8b01
中图分类号
R57 [消化系及腹部疾病];
学科分类号
100201 [内科学];
摘要
PURPOSE: Objectives of surgical treatment for transsphincteric and complex anorectal fistulas are the successful elimination of current/recurrent disease and the preservation of sphincter function. The concept of endorectal advancement flaps is to preserve the sphincter by closing off the primary opening by means of a mobilized flap. We performed a systematic review of the literature to assess the role of this technique. METHODS: A literature search on transanal rectal advancement flaps to treat cryptoglandular or Crohn fistula-in-ano was performed for the 30-year period between 1978 and 2008. Rectovaginal/rectourinary or cancer-related fistulas were excluded. Each study was examined for length of follow-up and the 2 major end points: success rate and incontinence rate. RESULTS: From 35 studies with 2065 patients, we identified 1654 patients undergoing endorectal advancement flaps for cryptoglandular or Crohn disease. Four hundred eleven subjects were excluded (319 rectovaginal/rectourinary fistulas; 92 other causes). The quality of the reports was limited (low-level evidence) with numerous structural and design flaws. Weighted success and incontinence rates were 80.8%/13.2% for cryptoglandular and 64%/9.4% for Crohn fistulas. CONCLUSION: Endorectal advancement flap is one tool, although not a perfect one, to treat complex anorectal fistulas of cryptoglandular or Crohn origin. Higher level evidence would be needed for comparison with other surgical techniques.
引用
收藏
页码:486 / 495
页数:10
相关论文
共 46 条
[1]
Abbas MA, 2008, AM SURGEON, V74, P921
[2]
MUCOSAL ADVANCEMENT IN THE TREATMENT OF ANAL FISTULA [J].
AGUILAR, PS ;
PLASENCIA, G ;
HARDY, TG ;
HARTMANN, RF ;
STEWART, WRC .
DISEASES OF THE COLON & RECTUM, 1985, 28 (07) :496-498
[3]
Obliteration of the fistulous tract with BioGlue® adversely affects the outcome of transanal advancement flap repair [J].
Alexander, S. M. ;
Mitalas, L. E. ;
Gosselink, M. P. ;
Oom, D. M. J. ;
Zimmerman, D. D. E. ;
Schouten, W. R. .
TECHNIQUES IN COLOPROCTOLOGY, 2008, 12 (03) :225-228
[4]
[Anonymous], 2009, OXF CTR EV BAS MED L
[5]
Efficacy of anal fistula plug in closure of cryptoglandular fistulas: Long-term follow-up [J].
Champagne, Bradley J. ;
O'Connor, Lynn M. ;
Ferguson, Martha ;
Orangio, Guy R. ;
Schertzer, Marion E. ;
Armstrong, David N. .
DISEASES OF THE COLON & RECTUM, 2006, 49 (12) :1817-1821
[6]
Dixon M, 2004, AM SURGEON, V70, P925
[7]
Endorectal advancement flaps in the treatment of high anal fistula of cryptoglandular origin:: Full-thickness vs. mucosal-rectum flaps [J].
Dubsky, Peter C. ;
Stift, Anton ;
Friedl, Josef ;
Teleky, Bela ;
Herbst, Friedrich .
DISEASES OF THE COLON & RECTUM, 2008, 51 (06) :852-857
[8]
Effect of tobacco smoking on advancement flap repair of complex anal fistulas [J].
Ellis, C. Neal ;
Clark, Stephen .
DISEASES OF THE COLON & RECTUM, 2007, 50 (04) :459-463
[9]
Fibrin glue as an adjunct to flap repair of anal fistulas: A randomized, controlled study [J].
Ellis, C. Neal ;
Clark, Stephen .
DISEASES OF THE COLON & RECTUM, 2006, 49 (11) :1736-1740
[10]
Elting AW, 1912, ANN SURG, V56, P744