The changes in resting anal pressure after performing full-thickness rectal advancement flaps

Autores de IIS La Fe

• Natalia Uribe Quintana

  Autor

• Eduardo García-Granero Ximénez

  Autor

Participantes ajenos a IIS La Fe

• Balciscueta, Zutoia
• Minguez, Miguel

Grupos

• Cirugía digestiva y Cuidados perioperatorios

  

  Leader

  Matteo Frasson

Abstract

Background: Advancement flap is an accepted approach for treating complex fistula-in-ano. The purpose was to evaluate the changes in resting pressure along the anal canal after performing a full-thickness flap. Methods: Manometric review of patients who have undergone a full-thickness rectal advancement flap procedure for complex anal fistulas of cryptoglandular origin. Recurrence and continence were evaluated. Resting Anal Pressure was assessed along the anal canal by two measures: maximum resting pressure(MRP) and inferior resting pressure(IRP) at 0.5 cm from the anal verge. Results: 119 patients were evaluated. Overall recurrence rate was5.9%. Anal continence was maintained intact in 76.5%. Manometric study showed a significant decrease in postoperative MRP(90.6 +/- 31.9 to 45.2 +/- 20 mmHg; p < 0.001), while IRP values did not differ significantly(28.2 +/- 18.3 to 23.2 +/- 13.5 mmHg; p = 0.1). Conclusions: Performing a full-thickness rectal flap causes a decrease of the MRP in the middle third of the anal canal, due to the inclusion of the internal sphincter in flap. It seems crucial to preserve the distal internal sphincter intact as it helps both to maintain the resting pressure in the lower third and avoid deformities of the anal margin. (C) 2017 Elsevier Inc. All rights reserved.

Keywords

• Complex anal fistula; Rectal advancement flap; Anal manometry