Direct appositional (no flap) closure of deep anal fistula

After sphincter-sparing core fistulectomy for deep anal fistula 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.

From November 1987 to January 2001, 44 patients underwent 46 core fistulectomies with flap-less direct appositional closure in our unit. Records were kept prospectively. Twenty-six fistulae (in 28 patients) appeared healed at two to five months follow-up and the patients had been discharged. A full review was mounted in May 2001, when 16 of the healed patients could be contacted and questionnaires completed. Two patients were excluded from the study.

The procedure failed in 16 patients initially and was found to have done so in two more at long-term follow-up (41% overall). Three patients had died and five could not be traced.

Simple appositional closure after core fistulectomy for deep anal fistula seems inferior to methods using flap reinforcement.