Direct appositional (no flap) closure of XXXX .

@entity1 @entity9292
OBJECTIVE: After sphincter-sparing core fistulectomy for @entity9292 most surgeons advance a rectal mucosal flap to reinforce closure of the internal opening. Our own method having for many years been simple appositional closure the resulting series presented an opportunity for comparison. @entity1 AND METHODS: From November 1987 to January 2001, 44 @entity1 underwent 46 core fistulectomies with flap-less direct appositional closure in our unit. Records were kept prospectively. Twenty-six fistulae (in 28 @entity1 ) appeared healed at two to five months follow-up and the @entity1 had been discharged. A full review was mounted in May 2001, when 16 of the healed @entity1 could be contacted and questionnaires completed. Two @entity1 were excluded from the study. RESULTS: The procedure failed in 16 @entity1 initially and was found to have done so in two more at long-term follow-up (41% overall). Three @entity1 had died and five could not be traced. CONCLUSION: Simple appositional closure after core fistulectomy for @entity9292 seems inferior to methods using flap reinforcement.
