PURPOSE: The purpose of this study was to evaluate the healing rate of transsphincteric perianal @entity292 after anocutaneous advancement @entity1912 repair and to examine the impact of this procedure on fecal continence. METHODS: Between January 1997 and June 1999, 26 consecutive @entity1 with a transsphincteric perianal @entity292 passing through the middle or upper third of the external anal sphincter underwent anocutaneous advancement @entity1912 repair. There were six female @entity1 , and the median age was 39 (range, 27-54) years. Twenty @entity1 (77 percent) had previously undergone one or more prior attempts at repair. With the @entity1 in the prone-jackknife position, the internal opening of the @entity292 was exposed using a Lone Star Retractor System, and the crypt-bearing tissue around the internal opening as well as the overlying anoderm was excised. An (inverted) U-shaped @entity1912 , including perianal skin and fat, was created. The base of the @entity1912 was approximately twice the width of its apex. The @entity1912 was advanced and sutured to the mucosa and underlying internal anal sphincter proximal to the closed internal opening. The median follow-up time was 25 months. Fecal continence was evaluated in 23 @entity1 by means of a questionnaire. RESULTS: Anocutaneous advancement @entity1912 repair was successful in 12 @entity1 (46 percent). Success was inversely correlated with the number of prior attempts. In @entity1 who had undergone no or only one previous attempt at repair (n = 9), the healing rate was 78 percent. In @entity1 with two or more previous repairs (n = 17) the healing rate was only 29 percent. In seven @entity1 (30 percent) continence deteriorated after anocutaneous advancement @entity1912 repair. Eleven @entity1 (48 percent) had a completely normal continence preoperatively. Two of these @entity1 (18 percent) encountered soiling and @entity322 for gas after the procedure, whereas two subjects (18 percent) complained of @entity717 . Twelve @entity1 (52 percent) presented with continence disturbances at the time of admission to our hospital. In this group, deterioration was observed in two @entity1 (17 percent). CONCLUSION: The results of anocutaneous advancement @entity1912 repair in @entity1 with no or only one previous attempt at repair are moderate. In @entity1 who have undergone two or more previous attempts at repair the outcome is poor. Based on the relatively low healing rate and deterioration of continence, this procedure seems less suitable for high transsphincteric @entity292 than transanal mucosal advancement @entity1912 repair.

Anocutaneous advancement @entity1912 repair of transsphincteric XXXX .

@entity1 :: ('9606', 'Species') :: ['patients', 'patient'] @entity322 :: ('MESH:D014549', 'Disease') :: ['incontinence'] @entity1912 :: ('241', 'Gene') :: ['flap'] @entity292 :: ('MESH:D005402', 'Disease') :: ['fistula', 'fistulas'] @entity717 :: ('MESH:D009069', 'Disease') :: ['accidental bowel movements']
@entity292 :: (MESH:D005402,Disease) :: ['fistulas']
