Fistulectomy and endorectal advancement flap repair for cryptoglandular anal fistula: recurrence and functional outcome over 10 years of follow-up.
PURPOSE
To examine long-term recurrence and anal continence of patients with anal fistula treated by fistulectomy and endorectal advancement flap repair.


METHOD
Retrospective analysis of a prospective cohort of 115 patients (77.4% males, mean age 48.9 years) requiring 130 procedures, with a minimum follow-up of 10 years. Recurrence included reappearance of fistula after wound healing or presence of an abscess or chronic suppuration in the operated area at follow-up. Fecal incontinence was evaluated by the Cleveland Clinic Florida (CCF-FI) fecal incontinence scoring system.


RESULTS
The mean and SD duration of the follow-up period was 155.5 (21.7) months. Recurrence developed in 31 (23.8%) cases, 28 (90.3%) of which within the first year, with a mean time to recurrence of 4.9 (2.9) months. The success rate was 76.2%. Anal continence was normal in 80% of patients before surgery, 63.8% at 1-year follow-up, and 71.5% at the end of follow-up (p < 0.001). Overall, continence worsened in 16.9% of cases. The mean (95% CI) CCF-FI score was 0.78 (0.35-1.21) preoperatively, 1.04 (0.64-1.43) at 1 year after surgery, 0.90 (0.52-1.29) at 5 years, and 1.16 (0.66-1.67) at the end of the study (p < 0.05). Neither recurrence nor continence was significantly associated with previous anal or fistula surgical procedures or complexity of the fistula.


CONCLUSION
In this study, fistulectomy and endorectal advancement flap repair was associated with a long-term high rate of success. Most recurrences occurred within the first year and continence showed a mild deterioration over time.


CLINICAL TRIAL REGISTRATION
Not applicable.
['Chaveli Diaz|Carlos|C|http://orcid.org/0000-0002-1194-925X', 'Esquiroz Lizaur|Irene|I|', 'Marzo Virto|José|J|', 'Oteiza Martínez|Fabiola|F|', 'Gonzalez Álvarez|Gregorio|G|', 'de Miguel Velasco|Mario|M|', 'Ciga Lozano|Miguel Ángel|MÁ|']
D001003:Anal Canal D005242:Fecal Incontinence D005260:Female D005500:Follow-Up Studies D006801:Humans D008297:Male D008875:Middle Aged D011446:Prospective Studies D012003:Rectal Fistula D012008:Recurrence D012189:Retrospective Studies D016896:Treatment Outcome
Anorectal continence Cryptoglandular fistula Long-term follow-up Transanal advancement flap repair Transsphincteric fistula