[Sliding flap-plasty in treatment of anal fistula: a prospective study]

The common therapy for trans- and intersphincteric fistula usually is opening the fistula tract. Healing and rough continence thereafter is uneventful, but when follow-up is intensified and patient are asked for slight soiling and discharge many minor complaints become evident. Therefore we started a series of patients suffering from inter-, trans-, extrasphincteric or supralevatoric fistula with an advancement flap procedure after excision of the fistula, without dissection of any muscle fibre. Up to now 23 patients were operated including 5 with Crohn's disease. 17/23 were healed primarily and 6/23 failed to heal with 5 successful reoperations. 4/5 Crohn's patients operated during quiescent disease are healed. No discharge or soiling was reported after a follow-up time from 5 months to almost 2 years. In conclusion advancement flap gives best results in respect to continence. The flap should include not only mucosa but underlying internal sphincter muscle fibres too.