What are the limitations and conflicting evidence on endorectal advancement flaps for preventing postoperative fecal incontinence after LAR

What is known

- In a cohort of 56 complex-fistula flap repairs, 21.4% reported disturbed continence and resting/squeeze pressures fell significantly after surgery. ¹ - A systematic review of 35 studies (1654 patients) reported ~9% incontinence at median 29 months, with additional series up to 10%, and risk increasing with repeated flaps. ^2,3 - Predictors of flap failure or incontinence could not be identified on multivariate analysis. ¹

What is unknown / caveats

- One series reports no effect on continence (87% continence preserved) versus others reporting measurable sphincter-pressure reduction and disturbed continence - No retrieved source ties advancement flaps to low anterior resection - Healing rates in CD vary widely (25–64%), limiting effectiveness estimates - Evidence is retrospective cohorts and reviews — no RCT - The premise linking advancement flaps to LAR is not supported by the indexed literature, which is about fistula repair.

## References

1. PMID: 16896993. (metadata not in corpus)

2. Lee JJ, Lightner AL. Management and Treatment of Perianal Fistulizing Crohn's Disease. Clin Exp Gastroenterol. 2025;18:291-303. PMID: 41415490.

3. Judge TA, Lichtenstein GR. Treatment of fistulizing Crohn's disease. Gastroenterol Clin North Am. 2004;33(2):421-54, xi-xii. PMID: 15177547.

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_Draft — generated by the IBDology RAG and not yet clinician-reviewed. Answers are grounded in the retrieved literature listed above; a high faithfulness score means the answer matches its sources, not that the sources are correct._