Can a flap help the plug ? Or vice versa ? Proposing a combined sphincter-sparing anal fistula repair.

BACKGROUND: To evaluate the results of a combination of fistulectomy with a rectal advancement flap and an anal fistula plug in the treatment of transsphincteric anal fistulas.

METHODS: All patients with a transsphincteric fistula and a limited number of anterior intersphincteric fistulas in female patients were registered from July 1(st), 2010 until November 30(th), 2012. All operations were performed by one surgeon (CdG). Patient data and results (healing, continence) were collected in a prospective database.

RESULTS: 28 patients were treated with a healing rate of 75% after one procedure. Four out of seven patients who failed to heal underwent a redo anal fistula plug and rectal advancement flap. Three of them were cured. Cumulative healing rate was 86% after two procedures. There were four minor complications. Mean postoperative Wexner score was 0.62.

CONCLUSIONS: Combination of anal fistula plug and rectal advancement flap in treating transsphincteric anal fistulas can result in good healing rates with minimal incontinence.