CR21P COMPLEX ANAL FISTULAS: PLUG OR FLAP?

Abstract

Purpose: Rectal mucosal advancement flaps (RMAF) and fistula plugs (FP) are techniques used to manage complex anal fistulas. The purpose of this study was to review and compare the results of these methods of repair.Methodology: A retrospective review of all complex anal fistulas treated, by either a RMAF or a FP, at Auckland City Hospital from 2004 to 2008. Comparisons were made in terms of successful healing rates, time to failure and the use of MRI.Results: Overall, 70 operations were performed on 55 patients (55.7% male). The mean age was 44.9 years. 21 patients (30%) had had at least 1 previous unsuccessful repair. Indications for repair included 57 high cryptoglandular anal (81%), 4 Crohn's anal (6%), 7 rectovaginal (10%), 1 rectourethral (1%) and 1 pouch‐vaginal fistula (1%). All patients were followed up with a mean of 4.5 months. 48 RMAF's (69% of total) were performed with 16 successful repairs (33%). 22 FP's (31% of total) were performed with 7 successful repairs (32%, p = 0.9). In failed repairs, there was no difference in terms of mean time to failure (RMAF 4.8 months vs. FP 4.1 months, p = 0.62). MRI was performed in 21 patients (37%) before the repair. The success rate in these patients was 20%.Conclusion: The results of treatment of complex anal fistulas are disappointing. The choice of operation of either a RMAF or a FP did not alter the poor healing rates of about one third of patients in each group.