The use of transanal rectal advancement flaps in the management of fistulas involving the anorectum.

摘要: Between 1981 and 1986, transanal rectal advancement flaps were employed in the surgical management of 39 anorectal fistulas at Cleveland Clinic. Included 23 low rectovaginal, 12 fistulas-in-ano and, four rectourethral fistulas. Nineteen occurred patients with Crohn's disease while other 20 included 11 due to obstetric or injury. This technique has become Clinic's standard for rectovaginal but is reserved complex fistulas-in-ano. Active proctitis malignancy are contraindications procedure. Surgery requires elevation a broad-based flap, curettage tract, primary suture flap over internal opening. Fistulas eradicated 27 cases (69.2 percent) including 19 (57.9 16 (80.0 from causes (mean follow-up 25 months). Rectovaginal healed 60.0 percent those compared 76.9 causes. Complex did less well. Only two six these healed. Temporary stomal diversion was used on nine occasions successful outcome achieved only four, indicative greater complexity cases. It concluded that can be an effective method repair region selected