Long-term outcome following mucosal advancement flap for high perianal fistulas and fistulotomy for low perianal fistulas: recurrent perianal fistulas: failure of treatment or recurrent patient disease?

Int J Colorectal Dis. 2006 Dec;21(8):784-90. doi: 10.1007/s00384-005-0072-7. Epub 2006 Mar 15.


Background: In this study, we determined the long-term outcome of perianal fistulas treated with mucosal advancement flap (MF) or fistulotomy (FT).

Methods: One hundred three patients with perianal fistulas were treated by MF for high fistulas or FT for low fistulas and were retrospectively assessed by case-note review and examined at the out-patient clinic. The localization and time of recurrence of the fistula were recorded.

Results: Forty-one patients [median follow-up of 72 months (range 48-99)] were treated by an MF, and 62 patients [median follow up of 75 months (range 48-99)] were treated by FT. After 12, 48, and 72 months, the fistula had recurred in 9 (22%), 26 (63%), and 26 (63%) patients of the MF group and in 4 (7%), 16 (26%), and 24 (39%) patients of the FT group, respectively. Eighteen (69%) of the recurrences in the MF group and ten (33%) of the FT group occurred within 24 months after surgery (p=0.01). Four (15%) of the recurrences in the MF group and 13 (54%) of the recurrences in the FT group were present in a different localization (p=0.007).

Conclusion: The success rate of both FT and MF techniques decreases with time. Recurrence appears to be caused by failure of treatment and by recurrent patient disease.

Publication types

  • Comparative Study

MeSH terms

  • Adult
  • Aged
  • Crohn Disease / complications
  • Crohn Disease / surgery
  • Digestive System Surgical Procedures / methods
  • Disease-Free Survival
  • Female
  • Follow-Up Studies
  • Humans
  • Intestinal Mucosa / pathology
  • Intestinal Mucosa / surgery*
  • Magnetic Resonance Imaging
  • Male
  • Middle Aged
  • Rectal Fistula / etiology
  • Rectal Fistula / pathology
  • Rectal Fistula / surgery*
  • Recurrence
  • Retrospective Studies
  • Severity of Illness Index
  • Surgical Flaps*
  • Time Factors
  • Treatment Failure