ENDOANAL ADVANCEMENT FLAP REPAIR FOR HIGH-LEVELED ANAL FISTULAE: CLINICAL AND MANOMETRIC RESULTS

Aim: The aim of this prospective study was to evaluate the functional outcomes after endoanal advancement flap (EAF) in treatment of high leveled anal fistulas. Methods: From October 2001 to December 2005, 32 patients with high anal fistulae underzvent EAF. They were 26 males and 6 females, with a mean age 37.75 ± 7.2 years. Seven patients had recurrent fistulae and five had minor anal incontinence. All patients underzvent coring fistulectomy folloived by endoanal advancement flap that was sutured to the anoderm below the level of the internal opening. Patients were followed up for 20.16 ± 5.87 months. Continence was evaluated using a special questionnaire. Results: EAF was successful zvith a complete healing in 24 patients (75%) whereas; the overall recurrence rate was 25% after a second operation. Also, 25 patients (78.3%) experienced improved or unaffected anal continence,whereas, seven patients (21.9%) experienced minor degrees of anal incontinence. Manometrically, all patients showed significant decrease in mean resting pressure (MRP) (P: 0.000) while there was no significant changes in mean squeeze pressure (MSP) (P: 0.069) or in the functional anal canal length (P: 0.753). Conclusion: EAF allows the treatment of transsphincteric fistulae as well as suprasphincteric fistulae without sacrificing anal sphincter function, which is likely to be superior to alternative procedures even in case of recurrence