الفهرس Only 14 pages are availabe for public view
 |  | from | 127 |  |  |
| | | from | 127 | | |
Abstract
Summary and conclusion
High and recurrent perianal fistulas are considered one of the common surgical problems that have been faced by many surgeons. As abscess fistulas sequence is the accepted hypothesis for pathogeensis of perianal fistulas, good drainage of perianal abscesses must be done to avoid the occurrence of perianal fistulas.
Laying open the track and fistulectomy are the common used techniques in management of low perianal fistulas. The results of these techniques are good and usually do not affect faecal incontinence but in the treatment of high perianal fistulas laying open the track and fistulectomy involve division of most of anal sphincter muscles resulting in some degree of faecal incontinence.
To avoid these complications, there are many surgical procedures that have been tried for preservation of anal sphincter and continence such as flap techniques and seton fistulotomy.
A flap technique aims to cover the internal opening by mucosal flap from above or anocutaneous flap from below and to open the external component of the fistula and draining any coexisting sepsis. In this study, 10 cases with recurrent, and/or high peri-anal fistulas were subjected to full history taking and full clinical examination in outpatient clinic.
Also, they were subjected to:
(1) Laboratory investigations as CBC, LFT, KFT, BT, CT and blood sugar.
(2) Fistulography and endo-anal ultrasonography.
(3) ECG and cardiovascular consultation for all patients above 40 years.
In this study, we used a V-Y advancement AAFR technique and it was found that this technique is chararcterized with simplicity, minimal blood loss, short period of nursing care, less wound infection, no incidence of flap ischaemia nor loss, and during the available follow up period. There were no incidence of faecal incontinence nor recurrence of fistulas.
We conclude that V-Y AAFR is a suitable method for the treatment of high and recurrent perianal fistulas as it preserves anal sphincter avoiding anal incontinence and no incidence of recurrence. References Aguilar J.G. (1996): Factors associated with recurrence and incontinence.