Endorectal sliding flap repair of complicated anterior anoperineal fistulas

This report presents experience with a safe and effective form of treatment for anal fistulas that involve a significant portion of the sphincter mechanism. The technique includes removal of the involved crypt, closure of the internal opening with a sliding endorectal flap, and counter drainage of the fistula tract. This series includes eight patients treated over a five-year period with a follow-up of up to five years. This limited series had no complications and one case of early recurrence. Most of these patients had had previous failed attempts at correction of the fistula. The main advantage of this mode of treatment is preservation of the integrity of the sphincter muscle, thus avoiding the high risk of incontinence that is inherent especially with anteriorly located fistulas in females. It is proposed that, because it does not transect the sphincter anteriorly, this technique is safer than the placement of setons, as has been previously advised for management of anterior fistulas. The different treatment techniques for anal fistulas, including complications, recurrence rates, surgical techniques, and indications for types of management are reviewed.