Advancement flap
Operation
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Prendre rendez-vousIndications
- High transsphincteric fistula (involving more than 30% of the anal sphincter).
- Anterior fistula in a woman (internal opening of the fistula anterior in the anal front sphincter in supine position).
- In case of recurrence of an anal fistula.
- In case of pre-existing fecal incontinence.
- Anal fistula with multiple internal openings and tracts.
Surgery
The aim of surgery is to close the internal opening of the fistula in the anal canal and covering it with healthy tissue of the intestine. The procedure is mostly performed with the patient in gynecological position. The procedure is mostly performed in 2 times with at least 6 weeks interval.
In the initial stage of the surgery, a ” Seton” drainage wire is placed through the internal and external opening to control the infection.
During the second stage, the internal opening in the anal canal is closed and a flap of healthy tissue from the bowel (rectum) is mobilized to cover the internal opening without tension.
- Exploration of the internal opening with a stylet, resection internal opening.
- Mobilisation of a flap of healthy tissue in the rectum.
- Suturing of the internal opening.
- Covering the internal opening with a healthy rectal flap.
- Suturing of the internal opening with the healthy rectal flap.
Duration of the procedure :
- +/- 40 min
Length of hospital stay :
- Day hospital
Wound healing :
- +/- 4 weeks semaines
Complications
Bleeding
- Incidence : Rare
Urinary retention
- Incidence : Rare
Infection
- Incidence : Rare
Recurrent anal fistula:
- Incidence : +/- 0 to 40 %
Normal – abnormal symptoms
Normal symptoms
- Anal pain is normal but should subside over time.
- Seepage of serous (yellowish) anal fluid.
- Fluid loss may be bloody but should subside over time.
Abnormal symptoms
Contact your surgeon or GP, or go to the emergency room:
- If pain increases over time.
- If fever does not subside over time.
- If pus volume increases or foul smelling viscous fluid increases.
- If blood loss persists.
If certain symptoms seem abnormal to you contact your doctor.
If this is not possible, you can contact avec your surgeon.
If you are unable to contact your GP or your surgeon, go to the emergency department at St Elizabeth Hospital in Uccle.
Functional Results
Incontinence
- Incidence : 0- 12 %
The risk of incontinence is minimal. There is no severe incontinence (uncontrolled loss of stools).