Surgical Treatment of Complex Anal Fistulas with the Anal Fistula Plug: A Prospective, Multicenter Study

Abstract

Because there is still no standard for the treatment of high transsphincteric fistulas and because recurrence rates are high for all procedures performed, new techniques are needed for this complex disease. Our success rate of 62% is promising because this technique can be used as a first approach to close the fistula tract without destruction of the sphincter muscle.

Tract Length Predicts Successful Closure With Anal Fistula Plug in Cryptoglandular Fistulas

“…25 Conversely, a randomized trial of the anal fistula plug vs the endorectal advancement flap was closed prematurely when 12 of 15 patients had a recurrence with the fistula plug at 1-year follow-up. 26 These 2 studies again demonstrate the wide range of results reported for the fistula plug.…”

“…Last, Hirschburger and colleagues identify smoking and diabetes as risk factors for plug failure. 25 These factors were not tracked in the current study. Future plug studies should seek to clarify the association of successful closure and tract length with respect to sphincter involvement, smoking, and diabetic status.…”

Successful closure of gastrocutaneous fistulas using the Surgisis® anal fistula plug

“…It represents the first minimally invasive alternative to formal fistula-inano surgery, recommended as a first line intervention for simple fistula-in-ano. [6][7][8] Innovators from the US have already described the use of the Surgisis ® anal fistula plug as a minimally invasive therapy for the management of fistulas not in the perineum. Wood et al described the successful closure of a solitary persistent gastrocutaneous fistula following removal of a PEG tube with a porcine fistula plug 9 and Paul et al describe similar success closing a solitary bronchopleural fistula following a partial pneumonectomy.…”

Treatment of Crohn's Fistulae Using an Anal Fistula Plug of Porcine Small Intestinal Submucosa Origin

“…It is now thought that mechanical debridement of the tract is necessary for good plug incorporation, especially since literature suggests that at least some anal fistula tracts may be epithelialized [21]. Furthermore, other authors have advocated the widening of the external opening following placement of the plug to ensure adequate drainage and prevent abscess formation [22]. While we mobilized a small flap of mucosa over the head of the plug to ensure that the plug was completely buried under the rectal mucosa, this practice was not routinely recommended at the time the study commenced.…”