Department of Colorectal Surgery, Cleveland Clinic Florida, Weston, Florida, USA.
Colorectal Dis. 2019 May;21(5):581-587. doi: 10.1111/codi.14564. Epub 2019 Feb 21.
Treatment of complex anal fistula (CAF) is challenging, often requiring multiple operations due to a high failure rate. The plethora of options attests to the lack of a panacea. Endorectal advancement flap (ERAF) carries the advantages of no sphincter division, no contour defect to the anal canal and no perineal wound. The failure rate of this procedure ranges between 15% and 60%. Although the procedure traditionally described a rhomboid (tongue-shaped) flap, an elliptical (curvilinear) flap was introduced to try to improve the results. This study aimed to describe the elliptical-shaped ERAF performed by the senior authors and others and compare failure rates between elliptical and rhomboid ERAFs for CAF.
A retrospective review of all patients who underwent ERAF for CAF between 2011 and 2017 was undertaken. Patients were divided into two groups based on the type of flap: rhomboid or elliptical. The main outcomes measures were postoperative persistent or recurrent fistula.
Seventy-six ERAF procedures for CAF were identified in 71 patients; 39 had a classic rhomboid flap and 37 had an elliptical configuration with mean follow-up of 13.8 and 13.9 months, respectively. The groups were similar for demographic parameters and preoperative fistula characteristics. The overall failure rate was 37%, with a success rate of 64% in the rhomboid and 62% in the elliptical group.
The shape of the ERAF for treatment of CAF does not appear to influence failure rate.
治疗复杂型肛痿（CAF）具有挑战性，由于高失败率，常需要多次手术。大量的治疗选择证明没有一种方法是万能的。经直肠内前位皮瓣推进术（ERAF）的优点为不切断括约肛，不会导致肛管轮廓缺陷，也不会产生会阴伤口。该手术的失败率在 15%至 60%之间。尽管传统的手术描述为菱形（舌状）皮瓣，但引入了椭圆形（曲线形）皮瓣，试图改善结果。本研究旨在描述资深作者及其他作者实施的椭圆形 ERAF，并比较 CAF 中椭圆形和菱形 ERAF 的失败率。
回顾性分析 2011 年至 2017 年间接受 ERAF 治疗 CAF 的所有患者。根据皮瓣类型将患者分为两组：菱形或椭圆形。主要观察指标为术后持续性或复发性痿管。
共确定了 71 例 76 例 CAF 患者接受 ERAF 治疗；39 例行经典菱形皮瓣，37 例行椭圆形皮瓣，平均随访时间分别为 13.8 个月和 13.9 个月。两组在人口统计学参数和术前痿管特征方面相似。总的失败率为 37%，菱形组成功率为 64%，椭圆形组成功率为 62%。
治疗 CAF 的 ERAF 形状似乎不会影响失败率。
