Annals of Coloproctology

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Original Article

Benign proctology,Surgical technique

Endorectal Advancement Flap With Muscular Plication in Anovaginal and Anterior Perineal Fistulas: Axel Egal, Isabelle Etienney, Patrick Atienza; Ann Coloproctol. 2021;37(3):141-145. Published online May 15, 2020; DOI: https://doi.org/10.3393/ac.2020.04.10.1

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7 Citations

Purpose
Endorectal mucosal advancement flap with muscular plication can ensure complete closure of anovaginal fistulas and preserve continence. The aim of this retrospective study was to show indications might be broadened to include anoperineal fistulas.
Methods
This retrospective study gathered all available data from patients with anovaginal or anterior perineal fistulas who underwent transanal advancement flap repair with muscular plication. A loose seton was passed in the fistula track prior to surgery in all patients. Fistula healing was defined as fistula closure during proctological examination associated with complete resolution of symptoms.
Results
Thirty-five patients were included from January 2011 to March 2017. Causes of fistula were various, mostly post-operative (34.3%, n = 12), obstetrical (17.1%, n = 6) and inflammatory (14.3%, n = 5). Success rate was 65.2%. Fistula healing was obtained in 60.0% of patients with Crohn disease in remission. Closure rate was higher in anterior perineal fistulas (89.0%) than in anovaginal fistulas (63.6%) even if it did not reach statistical significance. Slight fecal continence disorders were noted in 2 women (5.7%).
Conclusion
This study demonstrates the efficacy of transanal advancement flap repair with muscular plication for anovaginal and anterior perineal fistulas. Similar closure rates and smaller postoperative incontinence rates compared to the classical technique make this surgery an optimal solution whose efficacy appears to be sustainable over time.

Citations

Citations to this article as recorded by

Failure rates and complications of four sphincter-sparing techniques for the treatment of fistula-in-ano: a systematic review and network meta-analysis
G. Fuschillo, F. Pata, M. D’Ambrosio, L. Selvaggi, M. Pescatori, F. Selvaggi, G. Pellino
Techniques in Coloproctology.2025;[Epub] CrossRef
Mesenchymal Stem Cells for the Treatment of Complex Anovaginal and Rectovaginal Fistulas in Crohn's Disease: A Systematic Review
Kleuber Arias Meireles Martins, Isabela Coutinho Faria, Leonardo Januário Campos Cardoso, Pedro Henrique Gibram Gontijo, Ana Júlia da Silva Oliveira Bittarães, Mariana Menezes Corcinio, Bárbara Nogueira Braga, Mariana Lisboa de Jesus
Journal of Coloproctology.2025; 45(02): e1. CrossRef
Rectovaginal Fistulas Not Involving the Rectovaginal Septum Should Be Treated Like Anal Fistulas: A New Concept and Proposal for a Reclassification of Rectovaginal Fistulas
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Clinical and Experimental Gastroenterology.2024; Volume 17: 97. CrossRef
Initial Clinical Outcomes Using Umbilical Cord–Derived Tissue Grafts to Repair Anovaginal Fistula
Gala M. Godoy-Brewer, Oluwafemi P. Owodunni, Alyssa M. Parian, Leonardo C. Duraes, Florin M. Selaru, Susan L. Gearhart
Diseases of the Colon & Rectum.2023; 66(2): 299. CrossRef
Modern opportunities for treatment of patients with rectovaginal fistulas: literature review
P. N. Myshentsev, S. E. Katorkin, A. I. Kuzmina
Meditsinskiy sovet = Medical Council.2023; (13): 184. CrossRef
Is It a Refractory Disease?- Fecal Incontinence; beyond Medication
Chungyeop Lee, Jong Lyul Lee
The Ewha Medical Journal.2022;[Epub] CrossRef
A case report: Trans-Anal mucosal trapezoid flap for repair of Ano-vaginal fistula
Ratna Chopra, Yadav Pramod, Garg Ankit, Pandey Shruti
Indian Journal of Colo-Rectal Surgery.2020; 3(3): 71. CrossRef

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