Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

At a glance: The ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
ADVANCED SEARCH
Log in
Top
Techniques in Coloproctology
Published in: Techniques in Coloproctology 1/2018

01-01-2018 | Original Article

Early outcomes of fluorescence angiography in the setting of endorectal mucosa advancement flaps

Authors: J. S. Turner, A. Okonkwo, A. Chase, C. E. Clark

Published in: Techniques in Coloproctology | Issue 1/2018

Login to get access

Abstract

Background

Fistula-in-ano has a reported incidence of 31–34%. Besides fistulotomy, options for fistula repair are seton placement, endorectal advancement flap (ERAF), fibrin sealant, anal fistula plug and ligation of the intersphincteric fistula tract. Despite having a reported success rate as high as 75–98%, ERAF is not without complications, including flap breakdown, recurrence and fecal incontinence. Traditionally, maintaining a broad base to preserve blood supply has been advocated to reduce flap failure. And the aim of the present study was to evaluate outcomes of adult patients who underwent ERAF for complex fistula-in-ano with the use of intraoperative fluorescence angiography (FA) at our institution between July 2014 and July 2016.

Methods

We retrospectively reviewed consecutive cases of complex fistula-in-ano repair with ERAF and FA from a prospectively maintained dataset of adult patients with complex fistula-in-ano. Demographics, intraoperative data and 60-day outcomes were recorded and reviewed.

Results

Six patients [five males and one female with a mean age of 40 years (range 25–46 years)], with a total of seven fistulas, were identified. Six (85.7%) of these patients had undergone prior surgery for fistula-in-ano. No recurrences or complications of any type were noted at 2-week and 8-week follow-up. The majority of patients (71.4%) required flap revision based on intraoperative FA prior to flap fixation.

Conclusions

FA is safe and offers real-time assessment of flap perfusion prior to and after fixation in anal fistula repair. The rate of flap ischemia may be underestimated, and therefore, to improve outcomes in ERAF, intraoperative FA should be included in the surgical armamentarium.
Literature
1.
Lohsiriwat V, Yodying H, Lohsiriwat D (2010) Incidence and factors influencing the development of fistula-in-ano after incision and drainage of perianal abscesses. J Med Assoc Thail 93(1):61–65
2.
Ramanujam PS, Prasad ML, Abcarian H, Tan AB (1984) Perianal abscesses and fistulas. A study of 1023 patients. 2. Dis Colon Rectum 27(9):593–597CrossRefPubMed
3.
Farmer RG, Hawk WA, Turnbull RB Jr (1975) Clinical patterns in Crohn’s disease: a statistical study of 615 cases. Gastroenterology 68(4 Pt 1):627–635PubMed
4.
Visscher AP, Schuur D, Roos R et al (2015) Long-term follow-up after surgery for simple and complex cryptoglandular fistulas: fecal incontinence and impact on quality of life. Dis Colon Rectum 58(5):533–539CrossRefPubMed
5.
Hämäläinen KP, Sainio AP (1997) Cutting seton for anal fistulas: high risk of minor control defects. Dis Colon Rectum 40(12):1443–1446CrossRefPubMed
6.
Blumetti J, Abcarian A, Quinteros F et al (2012) Evolution of treatment of fistula-in-ano. World J Surg 36(5):1162–1167CrossRefPubMed
7.
Göttgens KW, Smeets RR, Stassen LP et al (2015) Systematic review and meta-analysis of surgical interventions for high cryptoglandular perianal fistula. Int J Colorectal Dis 30(5):583–593CrossRefPubMed
8.
9.
10.
Ommer A, Wenger FA, Rolfs T et al (2008) Continence disorders after anal surgery–a relevant problem? Int J Colorectal Dis 23(11):1023–1031CrossRefPubMed
11.
Golub RW, Wise WE Jr, Kerner BA et al (1997) Endorectal mucosal advancement flap: the preferred method for complex cryptoglandular fistula-in-ano. J Gastrointest Surg 1(5):487–491CrossRefPubMed
12.
Soltani A, Kaiser AM (2010) Endorectal advancement flap for cryptoglandular or Crohn’s fistula-in-ano. Dis Colon Rectum 53(4):486–495CrossRefPubMed
13.
Sonoda T, Hull T, Piedmonte MR et al (2002) Outcomes of primary repair of anorectal and rectovaginal fistulas using the endorectal advancement flap. Dis Colon Rectum 45(12):1622–1628CrossRefPubMed
14.
Jarrar A, Church J (2011) Advancement flap repair: a good option for complex anorectal fistulas. Dis Colon Rectum 54(12):1537–1541CrossRefPubMed
15.
Fisher OM, Raptis DA, Vetter D et al (2015) An outcome and cost analysis of anal fistula plug insertion vs endorectal advancement flap for complex anal fistulae. Colorectal Dis 17(7):619–626CrossRefPubMed
16.
Tan KK, Alsuwaigh R, Tan AM et al (2012) To LIFT or to flap? Which surgery to perform following seton insertion for high anal fistula? Dis Colon Rectum 55(12):1273–1277CrossRefPubMed
17.
Stremitzer S, Riss S, Swoboda P et al (2012) Repeat endorectal advancement flap after flap breakdown and recurrence of fistula-in-ano–is it an option? Colorectal Dis 14(11):1389–1393CrossRefPubMed
18.
Mizrahi N, Wexner SD, Zmora O et al (2002) Endorectal advancement flap: are there predictors of failure? Dis Colon Rectum 45(12):1616–1621CrossRefPubMed
19.
Jones IT, Fazio VW, Jagelman DG (1987) The use of transanal rectal advancement flaps in the management of fistulas involving the anorectum. Dis Colon Rectum 30(12):919–923CrossRefPubMed
20.
Christoforidis D, Pieh MC, Madoff RD, Mellgren AF (2009) Treatment of transsphincteric anal fistulas by endorectal advancement flap or collagen fistula plug: a comparative study. Dis Colon Rectum 52:18–22CrossRefPubMed
21.
22.
23.
Jafari MD, Wexner SD, Martz JE et al (2015) Perfusion assessment in laparoscopic left sided/anterior resection (PILLAR II): a multi-institutional study. J Am Coll Surg 220:82–92CrossRefPubMed
24.
Atallah SB, Albert MR, de Beche-Adams TC et al (2013) Application of laser-assisted indocyanine green fluorescent angiography for the assessment of tissue perfusion of anodermal advancement flaps. Dis Colon Rectum 56:797CrossRefPubMed
25.
Turner J, Clark C (2016) Fluorescence imaging in anorectal advancement flaps. Dis Colon Rectum 59(7):700CrossRefPubMed
Metadata
Title
Early outcomes of fluorescence angiography in the setting of endorectal mucosa advancement flaps
Authors
J. S. Turner
A. Okonkwo
A. Chase
C. E. Clark
Publication date
01-01-2018
Publisher
Springer International Publishing
Published in
Techniques in Coloproctology / Issue 1/2018
Print ISSN: 1123-6337
Electronic ISSN: 1128-045X
DOI
https://doi.org/10.1007/s10151-017-1732-7

Other articles of this Issue 1/2018

Techniques in Coloproctology 1/2018 Go to the issue

Original Article

Diverticular colovesical fistula: What should we really be doing?

Review

Intraoperative use of ICG fluorescence imaging to reduce the risk of anastomotic leakage in colorectal surgery: a systematic review and meta-analysis

Original Article

Outcomes of ileal pouch-anal anastomosis without primary diverting loop ileostomy if postoperative sepsis develops

Video Forum

Inferior pancreatic approach for laparoscopic splenic flexure mobilization

Original Article

Efficacy of autologous fat graft injection in the treatment of anovaginal fistulas

Editorial

Virtual reality simulation for surgery: from video games to transanal total mesorectal excision