Colorectal Unit, Department of General and Digestive Surgery, Arnau de Vilanova Hospital, Valencia, Spain.
Colorectal Dis. 2020 Nov;22(11):1649-1657. doi: 10.1111/codi.15251. Epub 2020 Jul 31.
Transanal flap is an attractive technique for complex fistulas. The aim of this study was to identify factors associated with poor outcome, recurrence and incontinence.
All patients who underwent an advancement flap for the treatment of a complex anal fistula between 1995 and 2019 were prospectively enrolled. The patient data obtained included age, sex, body mass index, comorbid conditions and smoking history. The fistula characteristics analysed included previous anal surgery, anatomy of the fistula according to Park's classification, horseshoe or supralevator extension and preoperative seton drainage. The postoperative data registered included complications, postoperative stay, recurrence and incontinence. Predictive factors for recurrence and incontinence were identified using univariate and multivariate analysis.
One hundred and ninety patients were included; 134 (70.5%) were men and the mean patient age was 50 years. The median length of follow-up was 44.6 months. The fistula recurred in 14 patients (7.3%). Before surgery, 20 patients (10.5%) reported incontinence symptoms. In the continent patients a Wexner postoperative score of 0 was identified in 79.4%. Wexner scores between 1 and 3 were observed in 17% and scores of 4 or more in five patients (3%). Factors associated with recurrence included age < 50 years (OR = 4.8, P = 0.02, 95% CI 1.2-19), smoking (OR = 4.1, P = 0.03, 95% CI 1-16.5) and suprasphincteric fistula (OR = 0.5, P = 0.01, 95% CI 0.2-0.8) in multivariate log regression analysis. Major incontinence was influenced by female sex and previous anal surgery (OR = 7.5, P = 0.003, 95% CI 1.6-34 and OR = 0.1, P = 0.007, 95% CI 0.1-0.7, respectively).
Full-thickness transanal advancement flap is a good treatment for complex anal fistula repair. This study provides relevant information on risk factors for failure of therapy and incontinence, which can help in advising patients before surgery and planning a good treatment strategy.
经肛门皮瓣转移术是治疗复杂性肛瘘的一种有吸引力的技术。本研究的目的是确定与不良结局、复发和失禁相关的因素。
前瞻性纳入 1995 年至 2019 年间接受经肛门皮瓣转移术治疗复杂性肛瘘的所有患者。获得的患者数据包括年龄、性别、体重指数、合并症和吸烟史。分析的肛瘘特征包括既往肛门手术、Park 分类的肛瘘解剖、马蹄形或高位括约肌上延伸以及术前挂线引流。术后数据包括并发症、术后住院时间、复发和失禁。使用单因素和多因素分析确定复发和失禁的预测因素。
共纳入 190 例患者；134 例（70.5%）为男性，患者平均年龄为 50 岁。中位随访时间为 44.6 个月。14 例（7.3%）患者出现肛瘘复发。术前，20 例（10.5%）患者报告存在失禁症状。在有节制的患者中，79.4%的患者术后 Wexner 评分为 0。17%的患者 Wexner 评分为 1-3，5 例（3%）患者评分为 4 或更高。复发的相关因素包括年龄<50 岁（OR=4.8，P=0.02，95%CI 1.2-19）、吸烟（OR=4.1，P=0.03，95%CI 1-16.5）和高位括约肌上瘘（OR=0.5，P=0.01，95%CI 0.2-0.8）。多因素逻辑回归分析显示，主要失禁受女性和既往肛门手术的影响（OR=7.5，P=0.003，95%CI 1.6-34 和 OR=0.1，P=0.007，95%CI 0.1-0.7）。
全层经肛门皮瓣转移术是治疗复杂性肛瘘的一种良好方法。本研究提供了与治疗失败和失禁相关的风险因素的相关信息，这有助于在术前为患者提供咨询并制定良好的治疗策略。
