van Oostendorp J Y, Eddarazi A, Molenaar C B H, Zimmerman D D E, Bemelman W A, Han-Geurts I J M
Department of Surgery, Amsterdam UMC, Location AMC, Amsterdam, The Netherlands.
Department of Surgery, Proctos Kliniek, Bilthoven, The Netherlands.
Tech Coloproctol. 2025 May 9;29(1):112. doi: 10.1007/s10151-025-03148-w.
Surgical treatment for perianal fistulas requires balancing fistula closure with the risk of complications such as incontinence. The advancement flap (AF) is a widely used sphincter-sparing technique, yet it appears to offer only marginally better outcomes compared to alternative techniques, with a notable incontinence rate. This study aimed to evaluate the success rate and long-term functional outcomes of AF at our tertiary referral center.
This retrospective cohort study analyzed prospectively collected data from electronic medical records and questionnaires distributed in December 2023. Patients aged 18 or older with primary or recurrent perianal fistulas treated with AF between 2013 and 2023 were included. Fistulas of non-cryptoglandular origin and rectovaginal fistulas were excluded. The primary outcome was fecal incontinence. Secondary outcomes included disease burden, fistula closure, and risk factors for recurrence.
Eighty-one patients were included; 37 (46%) were women, mean age was 45 years, and 93% had a complex fistula. The median follow-up was 27 months (IQR 15.5-64). Before AF, 36% reported some degree of incontinence, increasing to 80% at long-term follow-up after AF. Specifically, 20 out of 26 (77%) preoperative fully continent patients reported incontinence issues at long-term follow-up. Fistula disease impact on daily life was higher for those who failed AF repair. Primary fistula closure was achieved in 35 patients (43%). No risk factors for AF failure could be identified.
Advancement flap repair of perianal fistulas is challenging and can lead to fecal incontinence, so thorough preoperative counseling, consistent long-term follow-up, and further research comparing alternative sphincter-sparing techniques are warranted.
肛周瘘管的手术治疗需要在瘘管闭合与诸如失禁等并发症风险之间取得平衡。推进皮瓣术（AF）是一种广泛应用的保留括约肌技术，但与其他技术相比，其效果似乎仅略好一些，且失禁率较高。本研究旨在评估我院三级转诊中心AF的成功率和长期功能结局。
本回顾性队列研究分析了2023年12月前瞻性收集的电子病历数据和问卷调查结果。纳入2013年至2023年间接受AF治疗的18岁及以上原发性或复发性肛周瘘管患者。排除非隐窝腺源性瘘管和直肠阴道瘘。主要结局是大便失禁。次要结局包括疾病负担、瘘管闭合情况以及复发的危险因素。
共纳入81例患者；37例（46%）为女性，平均年龄45岁，93%患有复杂性瘘管。中位随访时间为27个月（四分位间距15.5 - 64）。在进行AF之前，36%的患者报告有一定程度的失禁，AF术后长期随访时这一比例增至80%。具体而言，26例术前完全控便的患者中有20例（77%）在长期随访时报告出现失禁问题。AF修复失败的患者，瘘管疾病对日常生活的影响更大。35例患者（43%）实现了原发性瘘管闭合。未发现AF失败的危险因素。
肛周瘘管的推进皮瓣修复具有挑战性，且可能导致大便失禁，因此术前应进行充分的咨询，进行持续的长期随访，并开展进一步研究以比较其他保留括约肌技术。
