Table 4.
Included studies focused on both anal and ano/rectovaginal fistulas after the PICO search
| Title | Authors, year | Study design | Years | Patients | Flap type | Assessment | Follow-up | Follow-up time | Success rate | Failure rate | Other results |
|---|---|---|---|---|---|---|---|---|---|---|---|
| “Advancement flap procedure in Crohn and non-Crohn perineal fistulas: a simple surgical approach” | Bessi et al. [9] | Prospective | 2006–2017 | 87 pts; 34 pts with CD (8 A/RVF) | PAF | MC, Cardiff-Hughes classification, HBI, PDAILE: | Clinical healing (no abscess, purulent discharge, EO, or further drainage) | Median 13 months (IQR 4–38 months) | 68% (23/34) total, anal 73% (19/26), A/RVF 50% (4/8) | 32% (11/34) | Absence of biological therapy in pts with CD associated with failure |
| “Sphincter-sparing surgery for complex anal fistulas: radiofrequency thermocoagulation of the tract is of no help” | Merlini I’Heritier et al. [11] | Case-matched | 2006–2018 | 87 pts; AF on 11 pts with CD (5 AVFs out of total AFs) | Plicated IAS covered with MAF | Not specified | Clinical healing (no abscess, purulent discharge, EO, or further drainage) | Median 23 months (5–45 months) for all AF pts | 64% (14/22) for all pts with CD (AF + TC) | 32% (10/31) for all AFs, not specified for CD | AF and CD independent predictors for healing |
| “Long-term healing after complex anal fistula repair in patients with Crohn’s disease” | Mujukian et al. [13] | Retrospective | 2008–2018 | 60 pts with CD; AF on 19 pts with CD (5 A/RVF) | 14 MAF, 5 CAF | EUA or MRI | Clinical healing (EO closure, no discharge or pain) | Median 66 months (range 6–192 months) | 23% total (MAF 14%, CAF 67%) | Not specified | Modest healing rates, LIFT predicts long-term healing |
| “Endorectal advancement flap with muscular plication in anovaginal and anterior perineal fistulas” | Egal et al. [10] | Retrospective | 2011–2017 | 35 pts (27 AVF); 5 pts with CD | SubMAF with muscular plication | Not specified | Clinical healing (fistula closure, complete resolution of flatus or stool passage) | Median 31 months (4–72 months) | 60% (3/5) | 40% (2/5) | |
| “Healing of rectal advancement flaps for anal fistulas in patients with and without Crohn’s disease: a retrospective cohort analysis” | Seifarth et al. [19] | Retrospective (prospective database) | 2010–2020 | 155 pts; AF on 55 pts with CD (16 RVF) | PAF | Not specified | Clinical (complete healing), EAUS | Median 7 months (2–12 months) | 47% (26/55) total, anal 54% (21/39), RVF 34% (5/16) | 53% (29/55) | No difference in healing rate between pts with or without CD |
CD, Crohn’s disease; A/RVF, ano/rectovaginal fistula; AVF, anovaginal fistula; RVF, rectovaginal fistulas; AF, advancement flap; MAF, mucosal advancement flap; PAF, partial-thickness advancement flap; CVAF, cutaneous advancement flap; IAS, internal anal sphincter; PDAI, Perianal Disease Activity Index; MC, Montreal classification; EUA, examination under anesthesia; MRI, magnetic resonance imaging; HBI, Harvey–Bradshaw Index; IQR, interquartile range; LIFT, ligation of intersphincteric fistula tract; EO, external orifice; TC, thermocoagulation; pts, patients; EAUS, endoanal ultrasound