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Identification of epithelialization in high transsphincteric fistulas
L E Mitalas1, R S van Onkelen, K Monkhorst
1Division of Colon and Rectal Surgery, Department of Surgery, Erasmus MC, University Medical Center, H 181,'s Gravendijkwal 230, 3015 CE Rotterdam, The Netherlands.
Techniques in Coloproctology
|January 11, 2012
Summary
Epithelialization of high transsphincteric fistulas is uncommon and does not impact the success rates of transanal advancement flap repair (TAFR) or TAFR with ligation of the intersphincteric fistula tract (LIFT).
Area of Science:
- Colorectal Surgery
- Surgical Pathology
Background:
- Transanal advancement flap repair (TAFR) is a primary treatment for high transsphincteric anal fistulas.
- Fistula tract epithelialization is a suspected factor in treatment failure.
Purpose of the Study:
- To determine the prevalence of fistula tract epithelialization.
- To evaluate the impact of epithelialization on TAFR and TAFR combined with LIFT outcomes.
Main Methods:
- Histopathological examination of 53 fistula specimens from 44 patients undergoing TAFR or TAFR with LIFT.
- Fistula tracts were excised and examined by a pathologist blinded to clinical data.
Main Results:
- Epithelialization was found in only 25% of distal tracts and 22% of intersphincteric tracts.
- No significant difference in treatment outcomes was observed between fistulas with or without epithelialization.
Conclusions:
- Epithelialization of high transsphincteric fistulas is infrequent.
- Fistula tract epithelialization does not appear to influence the success of TAFR or combined TAFR and LIFT procedures.