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

Abstract

Anal fistula plug repair of cryptoglandular anorectal fistulas is more successful for long-tract fistulas. Although the overall success is modest, limiting surgical indications to fistulas exceeding 4 cm may maximize benefits of the plug technique.

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

“…In our series, there were 14 (56%) tracts in males and 11 (44%) tracts in females. In contrast to results reported by others [18], more tracts healed in men than in women, supporting the literature that suggests that complex tracts, such as anterior fistula tracts in women, are notoriously difficult to heal [19]. Clearly, the disparate results published in the literature on the efficacy of the AFP may need to take gender, as well as tract length, into consideration when predicting best outcomes and choosing the ideal patient for the placement of the plug.…”

“…A recent study reported that tract length predicts the outcome of AFP placement [18]. In that report, tracts that were 4cm in length or longer were 3 times more likely to heal than tracts that were less than 4cm in length (61% vs. 21%).…”

Controversies in Fistula in Ano

“…The plug may however be useful in Crohn's fistulas, where it may be considered as an alternative treatment, although the success rate even in these cases is low [8][9][10][11]. Some studies have shown that longer tracts have better chances of closure [12]. Results with bioprosthetic plugs have shown higher results varying from 54 % to 72 %, although the test series have been very small [13][14][15].…”

S3 guidelines: cryptoglandular anal fistulas

“…Grundlagen und Indikationen des Analfistelplugs wurden 2007 in einem Konsensuspapier publiziert [58]. Die veröffentli-chen Literaturergebnisse bilden überwie-gend Beobachtungsstudien ab ( [8,39,47,48,51,79,82,94,132,153,156,175,196,197,229,240,241,257,269,282,283,295,322]; . Tab.…”