To LIFT or to flap? Which surgery to perform following seton insertion for high anal fistula?
Dis Colon Rectum
; 55(12): 1273-7, 2012 Dec.
Article
in En
| MEDLINE
| ID: mdl-23135586
ABSTRACT
BACKGROUND:
The ideal surgery following seton insertion for high anal fistulas remains debatable.OBJECTIVE:
This study aimed to compare the success between the endorectal advancement flap and the ligation of intersphincteric fistula tract techniques as the definitive procedure following seton placement.DESIGN:
This study is a retrospective review. SETTINGS This study was conducted at the Division of Colorectal Surgery, University Surgical Cluster, National University Health System, Singapore, between April 2006 and July 2011. PATIENTS ANDINTERVENTIONS:
After seton placement for high anal fistulas, 31 and 24 patients underwent the endorectal advancement flap and the ligation of intersphincteric fistula tract procedures. MAIN OUTCOMEMEASURES:
Failure was defined as the nonhealing of the surgical wounds or persistent discharge at the external opening.RESULTS:
We identified 31 patients with a median age of 49 (range, 19-74) years in the endorectal advancement flap group. The median interval from the seton procedure to the flap procedure was 13 (range, 4-284) weeks. Over a median follow up of 6 (range, 2-26) months, 29 (93.5%) patients had successful outcomes. There were 24 patients, median age 41 (range, 16-75) years, in the ligation of intersphincteric fistula tract group. The median interval from the seton placement to the definitive surgery was 14 (range, 8-74) weeks. Over a median follow-up of 13 (range, 4-67) months, 15 (62.5%) patients had successful outcomes. Hence when performed as the initial definitive procedure after a seton, the endorectal advancement flap technique had a significantly higher success rate in comparison with the ligation of intersphincteric fistula tract approach (93.5% vs 62.5%) (p = 0.006).CONCLUSION:
In patients who have had seton placement for high anal fistulas, the endorectal advancement flap technique is associated with better short-term outcomes in comparison with the ligation of intersphincteric fistula tract technique.
Full text:
1
Collection:
01-internacional
Database:
MEDLINE
Main subject:
Digestive System Surgical Procedures
/
Surgical Flaps
/
Rectal Fistula
Type of study:
Observational_studies
/
Risk_factors_studies
Limits:
Adolescent
/
Adult
/
Aged
/
Female
/
Humans
/
Male
/
Middle aged
Language:
En
Journal:
Dis Colon Rectum
Year:
2012
Document type:
Article
Affiliation country:
Singapur