Treatment of anal fistulas by partial rectal wall advancement flap or mucosal advancement flap: A prospective randomized study

Background: High transphincteric perianal fistula represents a technical challenge for surgical management. We compared the effects of partial rectal wall advancement flap versus the mucosal advancement flap in the treatment of high transphincteric perianal fistula in a randomized study in patients with anal fistula. Patients and Method: Consecutive patients treated for transphincteric anal fistula at our institution were evaluated for inclusion. Participants were randomly allocated to receive Group I: Fistulectomy, closure of internal sphincter and rectal advancement flap includes mucosa, submucosa, and circular muscle layer sutured 1 cm below the level of internal opening or Group II: The same as group one but the flap includes only mucosa and submucosa. Study variables included fistula closure rate, continence, morbidity, postoperative pain, hospital stay and quality of life. Results: Forty patients with high transphincteric perianal fistula were randomized and completed the study. Operative time was 31.6 ± 6.8 min in group I, and 29.4 ± 4.7 min in group II (P = 0.783). Hospital stay was significantly more in group 2 (96.35 ± 9.5 vs. 105.8 ± 13.23) (P = 0.014) Immediate postoperative complications, occurred in one patients (5%) exposed to disruption in group I and 6 patients (30%) in group II. Recurrence occurred in 2 patients (10%) in the group I and 8 patients (40%) in group II. Two patients (10%) in group I developed incontinence for flatus and no patients in the group II develop such complication. Conclusion: Partial thickness advancement flap is better than mucosal advancement flap. © 2010.