Long‐term outcome of the anal fistula plug for anal fistula of cryptoglandular origin

Abstract

The role of the fistula plug in the management of anal fistula of cryptoglandular origin remains debatable and warrants further evaluation.

Results of collagen plug occlusion of anal fistula: a multicentre study of 126 patients

“…A similar result for anterior fistulae has been observed after fistulectomy [7]. With regard to the fistula plug, Safar et al [26] operated 36 patients of whom 20 had an anterior-based fistula for an overall success rate of 14% and Tan et al [23] operated 30 patients with 20 anterior fistula for an overall success rate of 13%, supporting the findings of the present study. In contrast, neither Cintron et al [24], with success rates of 35% in 40 anterior fistulae and 37% in 38 posterior or lateral fistulae, nor McGee et al [29], with a success rate of 43% in 42 plug insertions, regardless of location, found any association between healing and the position of the fistula tract.…”

Definitive seton management for transsphincteric fistula‐in‐ano: harm or charm?

“…Setons have been used in two ways: (1) as draining setons to minimize the chance of recurrent suppurations while typically not addressing the fistula as such; or (2) as cutting setons in order to achieve a staged, slow‐motion fistulotomy . Other techniques that emerged with initial assertion of success included advancement flaps , fibrin glue injection , collagen plug and most recently the LIFT procedure . With broader and independent examination in the literature, none of these tools outperformed the others in terms of efficacy and complication rates .…”

“…A number of systematic reviews have been published on some of the other techniques . The fibrin glue overall had both minimal risks but also – and despite a number of favourable reports – minimal long‐term effectiveness of probably less than 10% due to unacceptably high recurrence rates . The anal plug came out with highly encouraging numbers but in broader terms appeared to have less than 50% success (2–86%) whereby a long, narrow and dry tract may be the best suited .…”

Fistulotomy or fistulectomy and primary sphincteroplasty for anal fistula (FIPS): a systematic review

“…The failure rate is approximately 30-60 % for established surgical procedures such as the endorectal advancement flap (ERAF) [3,4] and injection of biological glues [5,6]. Also the initial enthusiasm for even newer techniques, such as anal fistula plug [7,8] and ligation of the intersphincteric fistula tract (LIFT) [9,10], decreased at the long-term follow-up, with a recurrence rate of about 70-80 % and 30-60 %, respectively [11][12][13][14][15].…”