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Anal fistula plug is a valid alternative option for the treatment of complex anal fistula in the long term

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International Journal of Colorectal Disease Aims and scope Submit manuscript

Abstract

Objective

This prospective, two-centre study was designed to evaluate long-term outcomes when using a collagen plug to treat cryptoglandular anal fistulae.

Materials and method

Over 3 years, 60 consecutive patients with cryptoglandular fistulae were treated using an anal fistula plug by experienced surgeons. Preoperative, postoperative and follow-up data were collected in a dedicated database. Success was defined as the closure of all fistula openings and the absence of discharge. Faecal incontinence scores were administered at baseline and at 6 months follow-up.

Results

Eleven patients had multiple fistula tracts. All fistulae treated in this series were classified as complex. Seventeen fistulae were anterior tracts in females, and the remaining tracts were trans-sphincteric in nature. Thirty-eight tracts were recurrent. Mean operative time was 26 ± 10 min. No major complications, active sepsis or mortality were observed. Success rate with a mean follow-up of 13 months was 60% of patients and 70% of tracts. Mean time for recurrence was 5.7 months. Two recurrent patients were successfully treated with a redo plug procedure, and five were successfully closed with a post-plug fistulotomy, leading to a global 72% success rate without continence impairment. Of the patients with a minimum follow-up of 6 months (mean, 18.5 months; range, 6–34 months), 29 in 32 (90.6%) were healed at final evaluation. In these patients, the mean preoperative CCF incontinence score was 0.73. This was reduced to 0.14 at 6-month follow-up. The mean reduction of CCF incontinence score was −0.6 (95% CI, 1.3 to −0.1; p = 0.01).

Conclusion

Fistula tract treatment with the anal fistula plug is a safe and viable surgical option that should be offered to complex fistula patients. The reasons and risk factors for recurrence remain to be explored.

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Conflict of interests

There was no financial support or affiliation for this prospective study.

Author information

Authors and Affiliations

  1. Surgery Unit, Casa di Cura San Pio X, Via Francesco Nava, 31, 20159, Milan, Italy

    Leonardo Lenisa, Andrea Rusconi, Luigi Mascheroni & Jacques Mégevand

  2. Department of Surgical Sciences, University of Pavia, Pavia, Italy

    Leonardo Lenisa

  3. Department of Surgery, Hospital Valle de Hebron, Barcelona, Spain

    Eloy Espìn-Basany, Jordi Escoll-Rufino, Roberto Lozoya-Trujillo & Francesc Vallribera-Valls

Authors
  1. Leonardo Lenisa
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  2. Eloy Espìn-Basany
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  3. Andrea Rusconi
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  4. Luigi Mascheroni
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  5. Jordi Escoll-Rufino
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  6. Roberto Lozoya-Trujillo
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  7. Francesc Vallribera-Valls
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  8. Jacques Mégevand
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Corresponding author

Correspondence to Leonardo Lenisa.

Additional information

Partial data of the present series were accepted for poster presentation at the 2nd Scientific Meeting of the European Society of Coloproctology held in Malta, September 2007.

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Lenisa, L., Espìn-Basany, E., Rusconi, A. et al. Anal fistula plug is a valid alternative option for the treatment of complex anal fistula in the long term. Int J Colorectal Dis 25, 1487–1493 (2010). https://doi.org/10.1007/s00384-010-0957-y

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  • DOI: https://doi.org/10.1007/s00384-010-0957-y

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