Background: Complex anal fistula has been a hot topic in clinic. Many surgical techniques have been described for the treatment of such anal fistula, including the use of seton, fibrin glue, collagen plugs, rectal advancement flaps, fistulotomy with sphincter repair, and rerouting the fistula tract. However, the results have been variable, and no one procedure is superior to the others absolutely. It is worth our concern that the goal of any treatment procedure is to obliterate the tract and to have low recurrence rates while maintaining full continence. Comparison was made between the two procedures (re-routing and rectal advancement flap) to stand on the superiority of each one over the other. We compared data including: Healing time, post operative bleeding and infection, recurrence rates and continence. Patients and Methods: The study was conducted over 40 patients with high trans-sphincteric fistulas, randomly divided into 2 equal groups, who underwent Rerouting of the tract in one group and rectal advancement flap in the other group.
Results: Rerouting technique and rectal advancement flap have nearly similar incidence of post operative complications and continence but rectal advancement flap is associated with short healing period and a high recurrence rate as compared to re-routing technique.Conclusion: In patients with high trans-sphincteric anal fistulas, rectal advancement falp has a short healing period but a high recurrence rate which was statistically insignificant.