Eradication of perianal fistulas in IBD patients using the advancement flap method and risk factors associated with poor healing
Abstract
Complex perianal fi stulas 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 orifi ce 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 11.A.A.0 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. Rectovaginal localization was identifi ed as a signifi cant 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 fl aps (0.5 (0-8) vs3 (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 identifi ed as a significant risk factor of healing failure. Early surgical treatment according to protocol signifi cantly improves healing.