Endorectal / Endoanal Advancement Flap
A flap of healthy rectal tissue is advanced to close the internal fistula opening - the preferred sphincter-preserving surgical option for high and complex anal fistulas where sphincter division would risk incontinence.
What is Endorectal / Endoanal Advancement Flap?
The Endorectal Advancement Flap procedure closes the internal opening of a high or complex anal fistula by advancing a well-vascularised flap of healthy rectal mucosa and submucosal tissue to seal it. The external opening is separately curetted. The sphincter is completely preserved - making it one of the best sphincter-safe options for complex anal fistula surgery in Hyderabad. Dr. Samhitha Reddy performs advancement flap repair at Lux Hospitals, Hyderabad for high trans-sphincteric, suprasphincteric, and recurrent fistulas where other sphincter-preserving options have failed or are unsuitable. It is also a primary option for fistulas associated with Crohn's disease - as part of the comprehensive cost-effective fistula care in Hyderabad programme.
How the Procedure Works
Seton Phase (If Needed)
A draining seton is placed for 6–12 weeks if active infection or induration is present - resolving inflammation before the flap repair.
Flap Design
Under spinal or general anaesthesia, a U-shaped or trapezoidal flap of mucosa, submucosa, and a portion of the internal sphincter is designed above the internal opening.
Flap Elevation
The flap is carefully elevated, preserving its blood supply. The internal opening is curetted and the flap base is mobilised.
Internal Opening Closure
The internal opening is closed. The flap is advanced distally to cover the closed opening and sutured in place without tension.
External Tract Curettage
The external fistula tract is curetted through the external opening. External opening left open to drain. High-fibre diet and stool softeners prescribed post-operatively.
Outcomes
Who Needs This Treatment?
- →Sphincter completely preserved - appropriate for fistulas involving significant sphincter muscle
- →Brings healthy well-vascularised tissue to close the internal opening - critical for complex fistulas
- →Preferred option for Crohn's-related complex fistulas in Hyderabad
- →Can be performed after prior failed fistula surgery without compromising future options
- →No prosthetic material required - purely autologous tissue
- →Available at Lux Hospitals, Hyderabad as part of the leading fistula clinic programme
The advancement flap is one of the most technically satisfying procedures in colorectal surgery. When executed correctly with a tension-free closure of the internal opening, it provides durable closure even for the most complex fistulas - with the sphincter completely untouched.
— - Dr. Samhitha Reddy, Consultant Proctologist & Laparoscopic Surgeon
Common Questions
Frequently Asked
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