Long‐term functional and clinical outcomes following transanal advancement flap for complex anal fistula repair: are there predictors of recurrence and incontinence?

• Published in: Colorectal disease 2020-11, Vol.22 (11), p.1649-1657
• Main Authors: Uribe, N., Balciscueta, Z., Cuneo, B., Martín, M.C., Tabet, J., Torrijo, I., López, M.
• Format: Article
• Language: English
• Subjects: Age; anal fistula; Body mass index; Fistula; Fistulae; incontinence score; Multivariate analysis; Patients; rectal advancement flap; recurrence; Risk factors; Smoking; Surgery
• ISSN: 1462-8910; 1463-1318
• DOI: 10.1111/codi.15251

Aim 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. Method 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. Results 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