Our Summary

This paper looks at the results of a surgical procedure called a mucosal advancement flap (MAF), which is used to treat a severe type of anal fistula - a painful condition involving an abnormal connection between the rectum and skin. The procedure can often need to be repeated if the condition comes back, which it can do quite often.

The researchers looked back at the records of 121 patients who had this procedure done by the same senior surgeon, and found that in about a quarter of cases (32 patients), the condition came back and they needed to have the operation again.

The good news is that the second procedure was successful in about 78% of these cases. For those few whose condition came back a third time, doing the operation again worked every time. The rate of complications was about the same for both the original group and those who had to have the procedure a second time - roughly 9%.

The study concludes that doing the MAF procedure again for recurrent cases is effective. The success rate for the second operation isn’t impacted by the fact the patient has already had the procedure once. The complication rate is also in line with what’s been previously reported in other studies.

FAQs

  1. What is a mucosal advancement flap (MAF) procedure used for?
  2. How often does the condition return after the initial MAF procedure?
  3. Is the success rate of the second operation impacted if a patient has already had the procedure once?

Doctor’s Tip

One helpful tip a doctor might tell a patient about anal fistula surgery is to be aware that the condition can come back and may require additional procedures. It’s important to follow up with your doctor regularly and report any new symptoms or concerns. Additionally, maintaining good hygiene and following post-operative care instructions can help reduce the risk of complications and improve healing outcomes.

Suitable For

Patients who are typically recommended anal fistula surgery are those with severe anal fistulas that do not respond to conservative treatments such as antibiotics or fistula plugs. In particular, patients with recurrent anal fistulas or those with complex fistula tracts may benefit from surgery. Additionally, patients with symptoms such as persistent pain, discharge, or infection related to their fistula may also be candidates for surgery. Ultimately, the decision to undergo anal fistula surgery should be made in consultation with a healthcare provider who can assess the individual patient’s specific condition and determine the most appropriate treatment plan.

Timeline

Before anal fistula surgery:

  • Patient experiences symptoms such as pain, swelling, discharge, and recurrent infections around the anal area.
  • Patient undergoes a physical examination and possibly imaging tests to diagnose the anal fistula.
  • Treatment may involve antibiotics, pain management, and draining of the abscess associated with the fistula.

After anal fistula surgery:

  • Patient undergoes the MAF procedure to treat the anal fistula, which involves removing the affected tissue and creating a flap to cover the fistula tract.
  • Recovery from the surgery may involve pain management, antibiotics, and proper wound care.
  • Follow-up visits with the surgeon are scheduled to monitor healing and address any complications.
  • In cases where the fistula recurs, the patient may need to undergo the MAF procedure again.
  • Repeat procedures may be necessary in some cases, but the success rate for subsequent surgeries remains high, with a low rate of complications reported.

Overall, the timeline for a patient before and after anal fistula surgery involves diagnosis, treatment, recovery, and possibly repeat procedures to effectively manage the condition and prevent recurrence.

What to Ask Your Doctor

  1. How likely is it that my anal fistula will come back after the MAF procedure?
  2. What is the success rate of the MAF procedure for treating anal fistulas?
  3. What are the potential complications or risks associated with the MAF procedure?
  4. How many times can I have the MAF procedure done if my anal fistula recurs?
  5. Are there any alternative treatments or procedures available for treating anal fistulas?
  6. How long is the recovery period after the MAF procedure?
  7. Will I need to make any lifestyle changes or follow a special diet after the surgery?
  8. How soon after the surgery can I resume normal activities, such as work or exercise?
  9. Are there any warning signs or symptoms I should watch out for after the surgery?
  10. How often will I need follow-up appointments to monitor my healing progress?

Reference

Authors: Podetta M, Scarpa CR, Zufferey G, Skala K, Ris F, Roche B, Buchs NC. Journal: Int J Colorectal Dis. 2019 Jan;34(1):197-200. doi: 10.1007/s00384-018-3155-y. Epub 2018 Sep 5. PMID: 30187157