Predictors of outcome after transanal advancement flap repair for high transsphincteric XXXX .

@entity1 @entity292 @entity28
BACKGROUND: Transanal advancement flap repair fails in 1 of every 3 @entity1 with a high transsphincteric @entity292 . It has been reported that smoking, @entity28 , and previous attempts at repair adversely affect the outcome of transanal advancement flap repair. Because these findings could not be confirmed by other studies, it is still unclear whether these and other factors have an impact on the outcome. OBJECTIVE: The aim of this study was to identify predictors of outcome in a large cohort of @entity1 who underwent transanal advancement flap repair for a high transsphincteric @entity292 . DESIGN: This study was performed as a retrospective review. SETTINGS: The study was conducted at the Division of Colon and Rectal Surgery, Erasmus MC, between 2000 and 2012. @entity1 : A consecutive series of 252 @entity1 with a high transsphincteric @entity292 of cryptoglandular origin were included. @entity1 with a rectovaginal or Crohn @entity292 were excluded. INTERVENTIONS: All @entity1 underwent transanal advancement flap repair. Preoperatively, @entity1 underwent endoanal MRI. MAIN OUTCOME MEASURES: Healing was defined as complete wound healing with absence of symptoms. @entity1 were followed up to assess failure. Seventeen @entity1 - and @entity292 -related variables were assessed. RESULTS: Median duration of follow-up was 21 months (range, 6-136 months). The failure rate at 3 years was 41% (95% CI, 34-48). None of the studied variables predicted the outcome of flap repair except horseshoe extension. In univariate and multivariate analyses, significantly less failures were observed in @entity1 with a horseshoe extension (p < 0.05). LIMITATIONS: Retrospective design, a single surgeon series, and potential selection bias caused by the tertiary referral center status are the limitations of this study. CONCLUSIONS: Of all studied variables, horseshoe extension was found to be the only positive predictor of outcome after flap repair for high transsphincteric @entity292 .
