Endorectal Advancement Flap Repair with the Use of Fluorescence Angiography: A Case Control Study

Adatee Okonkwo1, Ayana Chase2 and Jacquelyn Turner3*

1Department of Surgery, Morehouse School of Medicine, Atlanta, GA, USA 2Department of Surgery, Section of Colon and Rectal Surgery, Morehouse School of Medicine, Atlanta, GA, USA
3Department of Colon and Rectal Surgery, Morehouse School of Medicine, Atlanta, GA, USA

^*Correspondance to: Jacquelyn Turner 

 PDF  Full Text DOI: 10.25107/2474-1647.2846

Abstract

Background: Endorectal Advancement Flap (ERAF) is a technique that has been modified over the past century to treat anorectal fistulas. To further reduce complications with ERAF, Fluorescence Angiography (FA) has been utilized to assess flap perfusion. Here, we compare early outcomes of anal fistula repair utilizing ERAF with FA to traditional treatment modalities to assess safety and feasibility. Methods: We retrospectively reviewed cases of complex fistula-in-ano repair by board certified colorectal surgeons from 2013 to 2017 at a single safety-net urban hospital. Patients who underwent fistulotomy, ERAF, and ERAF with FA were grouped by procedure type (Group A, B, and C, respectively). Results: Sixty-four persons were identified that met inclusion criteria; 48 in Group A, 6 in Group B, and 10 in Group C. There was no difference in demographics between the three groups. Mean follow-up for all groups was 159.8 days (± 42 days). Group B and C had higher rate of prior surgeries (66.7% and 80%, respectively) when compared to group A (27.1%, p=0.001). Despite Group B and group C having a higher rate of complexity as suggested by a significantly higher re-operative surgery rate, there was no significant differences in postoperative complication rates among the three groups. There were no mortalities in either group. Conclusion: ERAF with FA is safe and feasible and should be considered when managing complex fistula-in-ano.

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Cite the article

Okonkwo A, Chase A, Turner J. Endorectal Advancement Flap Repair with the Use of Fluorescence Angiography: A Case Control Study. Clin Surg. 2020; 5: 2846..