✦ FLAP-BASED FISTULA CLOSURE

Endorectal / Endoanal Advancement Flap

Q: Will advancement flap affect my continence?

No. Advancement flap is specifically designed to preserve the sphincter muscle completely. Continence is fully maintained, making it ideal for high fistulas where sphincter protection is essential.

Q: Is this technique suitable for recto-vaginal fistulas?

Yes. Endorectal advancement flap is one of the preferred techniques for recto-vaginal fistulas. As a female proctologist, Dr. Tejasree provides especially sensitive, dignified care for women with these complex problems.

Q: What if the flap does not heal?

If healing is incomplete, options like LIFT, laser closure (FiLaC), VAAFT, or repeat advancement flap can be considered. The technique can sometimes be safely repeated.

Q: How long is the recovery?

Most patients return to office work within 2–3 weeks. Complete healing takes 4–6 weeks. Sitz baths, dressings, dietary advice, and avoiding straining support comfortable recovery.

Sphincter-sparing surgery for complex fistulas — a flap of healthy rectal tissue is mobilised and used to cover and close the internal opening of the fistula.

60–90 min PROCEDURE

1–2 Days HOSPITAL STAY

>75% SUCCESS RATE

2–3 Weeks RETURN TO WORK

What is Endorectal / Endoanal Advancement Flap?

Endorectal / Endoanal Advancement Flap is a sphincter-sparing surgical technique for complex anal fistulas, particularly high transsphincteric, suprasphincteric, or recto-vaginal fistulas. A flap of healthy rectal mucosa and submucosa is carefully mobilised and advanced down to cover and close the internal opening of the fistula. This protects the sphincter muscle while providing healthy, well-vascularised tissue to seal the tract. As a female proctologist in Hyderabad, Dr. Tejasree Vengala performs advancement flap surgery at Lux Hospitals, Hyderabad, particularly valuable for complex fistulas in women.

Suitable for complex high anal fistulas, recurrent fistulas after previous surgery, recto-vaginal fistulas, and select Crohn's-related fistulas — particularly when sphincter preservation is essential.

How the Procedure Works

Anaesthesia & Positioning

Surgery is performed under spinal or general anaesthesia. The patient is positioned in lithotomy or prone position.

Examination & Tract Mapping

The internal and external openings are clearly identified, and the full course of the fistula tract is mapped.

Tract Curettage & Closure

The fistula tract is curetted, and the internal opening is carefully closed in layers with absorbable sutures.

Flap Mobilisation & Advancement

A broad-based flap of healthy rectal mucosa and submucosa is mobilised and advanced down to cover the closed internal opening tension-free.

Recovery & Discharge

Patients are discharged in 1–2 days with structured wound care, dietary advice, and a clear follow-up plan.

Outcomes

60–90 minDURATION

1–2 DaysHOSPITAL STAY

>75%SUCCESS RATE

4–6 WeeksFULL HEALING

Who Needs This Treatment?

→Complete sphincter preservation — full continence maintained
→Effective for complex and recurrent fistulas
→Well-vascularised flap promotes durable healing
→Particularly useful for recto-vaginal fistulas
→Reliable option in Crohn's-related fistulas
→Discreet, sensitive care by a female proctologist

The advancement flap is one of the most elegant operations in proctology — bringing healthy, well-vascularised tissue down to seal a difficult fistula while protecting every fibre of the sphincter. For women with recto-vaginal or complex fistulas especially, it is often the most thoughtful, dignified choice.

— — Dr. Tejasree Vengala, Consultant Proctologist & Laparoscopic Surgeon, Lux Hospitals, Hyderabad

Common Questions

Frequently Asked Questions

Will advancement flap affect my continence?+

Is this technique suitable for recto-vaginal fistulas?+

What if the flap does not heal?+

How long is the recovery?+

Not sure which treatment is right for you?

Book a consultation with Dr. Tejasree Vengala and get a personalised treatment plan.

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