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a hepatologie

Gastroenterology and Hepatology

Gastroent Hepatol 2015; 69(1): 25–28. doi:10.14735/amgh201525.

Eradication of perianal fistulas in IBD patients using the Advancement Flap method and risk factors associated with poor healing

Zuzana Šerclová  1, Ondřej Ryska  1, Jaroslav Kalvach2, Jaroslav Marvan3

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Complex perianal fistulas largely influence the life of IBD patients. Conservative treatment methods do not lead to complete healing. The success rate of surgical treatment by a closure of the inner opening by advancement flap (AF) varies between
24–100%. The aim of the study was to identify the risk factors of impaired healing of AF in IBD patients and to evaluate the long-term results of fistula eradication. Methods: IBD patients from a prospective database operated using the AF method in the period 2005–2013 were enrolled. Patients were pretreated with long-term perianal drainages. Continuing secretion from the external orifice occurring within three months following the AF was evaluated as healing failure. Fistulas that appeared after this period were evaluated as a relapse. Statistical analysis was performed using the MedCalc software. Results: A total of 101 patients – 59 females (58%), age 35 ± 10 years, were followed for 17 (4–88) months. The interval between the first drainage to AF was 11 (1–58) months. Primary healing was achieved in 88 (87%)  patients, the recurrence rate was 6%. Concomitant therapy did not influence the healing. Recto-vaginal localization was identified as a significant risk factor of impaired healing (RR 2.88; CI 95%: 1.1–7.8). The pretreatment period before a surgical intervention by the authors was significantly shorter in the group of patients with successfully healed flaps (0.5 (0–8) vs 3 (0–10) years; p = 0.001). Conclusion: The success rate of eradication of complex perianal fistulas in IBD patients by the AF method is high, with a low frequency of healing failure (13%) and low recurrence rate (6%). Recto-vaginal localization of fistulas was identified as a significant risk factor of healing failure. Early surgical treatment according to protocol significantly improves healing.


advancement flap, complex perianal fistula, risk factors

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