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A Novel Murine Model of Arteriovenous Fistula Failure: The Surgical Procedure in Detail
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Mucosal advancement flap for recurrent complex anal fistula: a repeatable procedure
Michele Podetta1,2, Cosimo Riccardo Scarpa3, Guillaume Zufferey3
1Proctology Unit, Service of Visceral Surgery, Geneva University Hospitals and Medical School, Geneva, Switzerland. michelepodetta@gmail.com.
International Journal of Colorectal Disease
|September 7, 2018
Summary
A second mucosal advancement flap (MAF) is a feasible option for recurrent complex anal fistulas (AF), achieving a high success rate without compromising healing or significantly increasing complication risks. This approach offers a viable solution for previously treated AF patients.
Area of Science:
- Colorectal surgery
- Gastroenterology
- Surgical innovation
Background:
- Complex anal fistulas (AF) often require advanced surgical techniques.
- Mucosal advancement flap (MAF) is a primary treatment for complex AF.
- Recurrence after MAF presents a challenge for surgical management and incontinence risk.
Purpose of the Study:
- To evaluate the feasibility and outcomes of a second MAF procedure for recurrent complex AF.
- To assess the success rate, complication rate, and functional outcomes of repeat MAF.
- To determine if prior MAF impacts healing rates in subsequent procedures.
Main Methods:
- Retrospective analysis of 32 patients undergoing two or more MAF for recurrent complex AF.
- Inclusion criteria: complex AF of cryptoglandular origin previously treated with MAF.
- Long-term follow-up collecting clinical and functional data.
Main Results:
- A second MAF procedure had a success rate of 78.1% in patients with recurrent complex AF.
- The complication rate (Clavien Dindo 3b) for a second MAF was 9.4%, comparable to primary MAF.
- No significant change in continence scores was observed after the second MAF in patients with pre-existing deficits.
Conclusions:
- Mucosal advancement flap (MAF) is an effective treatment for complex recurrent anal fistulas (AF).
- A prior MAF procedure does not negatively affect the healing rate of a subsequent MAF.
- Repeat MAF procedures demonstrate comparable complication rates to initial MAF treatments.
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