✦ ANAL FISTULA · SPHINCTER-PRESERVING

Advancement Flap Surgery

Q: What causes advancement flap failure?

The most common causes are flap ischaemia from inadequate blood supply, persistent infection, or tension on the repair.

Q: Can the flap be repeated if it fails?

Yes, if the flap fails, another sphincter-preserving technique (repeat flap, FiLaC, or LIFT) can be attempted. Flap failure does not worsen sphincter function.

Q: Is advancement flap suitable for Crohn's fistulas?

With careful patient selection and well-controlled Crohn's disease, advancement flap can be performed. Success rates are lower than in non-Crohn's patients.

Rectal mucosal flap covering the internal fistula opening — sphincter-preserving surgery for high transsphincteric fistulas.

60–120 Min TREATMENT DURATION

2–3 Days CARE SETTING

Surgical APPROACH

2–3 Weeks RECOVERY TIMELINE

What is Advancement Flap Surgery?

Advancement flap surgery treats complex anal fistulas by closing the internal opening with a mobilised flap of healthy rectal mucosa, submucosa, and muscle. The flap is advanced over the closed internal opening, replacing diseased mucosa with vascularised healthy tissue. Dr. Tagore Mohan Grandhi performs advancement flap surgery for high transsphincteric, suprasphincteric, and rectovaginal fistulas. No sphincter is divided at any point, making it suitable for complex fistulas where other sphincter-preserving options have failed.

Suitable for patients with high transsphincteric or suprasphincteric fistulas where other sphincter-preserving options have failed — or as a primary option for rectovaginal fistulas.

How the Procedure Works

Internal Opening Excision

Internal opening and surrounding diseased tissue excised. Fistula tract curetted. Rectal wall assessed for flap viability.

Flap Design

Trapezoidal or tongue-shaped flap of rectal mucosa, submucosa, and circular muscle designed with a wide vascular base above the internal opening.

Flap Mobilisation

Flap elevated and advanced downward to cover the closed internal opening defect under no tension.

Flap Suturing

Flap sutured to fresh well-vascularised edges covering the internal opening. External opening curetted and left open.

Healing

Sutures removed at 10–14 days. MRI at 3 months to confirm fistula closure.

Outcomes

60–120 MinTREATMENT DURATION

2–3 DaysCARE SETTING

SurgicalAPPROACH

2–3 WeeksRECOVERY TIMELINE

Who Needs This Treatment?

→Addresses internal opening directly with vascularised healthy tissue
→No sphincter muscle divided — complete continence preservation
→Applicable to high transsphincteric, suprasphincteric, and rectovaginal fistulas
→60–80% cure rate in specialist hands

The advancement flap brings healthy, well-vascularised tissue directly to the internal fistula opening, closing the source of contamination with the best tissue available. In the right patient, the results are excellent.

— Dr. Tagore Mohan Grandhi, Senior Consultant Gastrointestinal Surgeon, Lux Hospitals, Hyderabad

Common Questions

Frequently Asked Questions

What causes advancement flap failure?+

Can the flap be repeated if it fails?+

Is advancement flap suitable for Crohn's fistulas?+

Not sure which treatment is right for you?

Book a consultation with Dr. Tagore Grandhi and get a personalised treatment plan.

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