Treatment for anal fistulas in patients with Crohn's disease is still challenging, even for the expert surgeon. The advancement flap technique is characterized by the preservation of the anal sphincter complex.
MethodsA systematic review of the literature, selecting series of patients affected by Crohn's disease and anal fistulas and treated using advancement flap technique was performed. Patients followed during at least 6 months have been included.
ResultsFrom 128 initial studies, 11 studies were selected, including overall 135 patients. Those studies show low-level evidence. Results in a series with follow-up from 8.4 to 82 months, stated a clinical success of 66% and recurrence rate around 30%. However there was an evident heterogeneity of results.
ConclusionThe review concludes that the advancement flap technique to treat anal fistulas in patients with Crohn's disease is an adequate alternative. New studies are necessary to provide higher-level evidence.
La técnica de colgajo de avance endorrectal es una de las alternativas en el tratamiento de la fístula anal en pacientes con enfermedad de Crohn.
MétodosDiseñamos una revisión sistemática de la literatura, seleccionando estudios que incluyeron a pacientes afectos de enfermedad de Crohn y fístula anal tratados mediante esta técnica. De esos estudios solo se seleccionaron los pacientes seguidos durante al menos 6 meses.
ResultadosSe seleccionaron 11 estudios con un total de 135 pacientes. Los resultados, con seguimientos de 8,4 a 82 meses, indicaron una curación del 66% y una tasa de recurrencia de alrededor del 30%. Sin embargo, se observó importante heterogeneidad en los resultados de las series revisadas.
ConclusionesEl colgajo de avance endorrectal es una alternativa adecuada en los pacientes con fístula anal y enfermedad de Crohn. Sin embargo, es necesario desarrollar nuevos estudios que aporten un mayor nivel de evidencia científica.
