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

Blom, Johannes; Husberg-Sellberg, B.; Lindelius, Anna; Gustafsson, Ulla-Maria; Carlens, S.; Oppelstrup, Henrik; Bragmark, Mats; Yin, Li; Nyström, P-O

doi:10.1111/codi.12585

Cited by 16 publications

(9 citation statements)

References 32 publications

(51 reference statements)

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“…A multicenter study showed that anterior fistulae were less likely to heal compared to fistulae in other locations. A success rate of 12% was observed for patients with an anterior fistula compared to 32% for those with posterior tracks [5]. Our study could not reproduce these data, and we had a greater healing rate for anterior fistulae, with a success rate of 70% for the anterior fistulae versus 55% for the posterior fistulae.…”

Section: Discussionmentioning

confidence: 88%

“…Early results were promising, showing a success rate of up to over 80% with the use of the Cook-Surgisis anal fistula plug [2-4]. Subsequent reports were not able to replicate that high success rate [5-7]. Thus, the aim of this study was to assess the healing rate in our department when using both the Cook-Surgisis and the Gore fistula plugs and to evaluate the long-term effectiveness of using an anal plug to manage high anal fistulae.…”

Section: Introductionmentioning

confidence: 99%

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Efficacy of Plug Treatment for Complex Anorectal Fistulae: Long-term Danish Results

Hansen

Andersen

2019

Ann Coloproctol

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Purpose Bioprosthetic plugs are appealing, allow simple, repeatable applications, preserve sphincter integrity, minimize patient discomfort, and allow subsequent surgical options when needed. However, success rates vary widely. This study assessed the healing rate in our department when both the Cook-Surgisis and the Gore fistula plugs were used and the long-term effectiveness of using anal plugs for managing anal fistulae. Methods A chart review was performed for patients who had undergone plug insertion between January 2008 and December 2015 at Copenhagen University Hospital, Hvidovre. Data were collected through a prospectively collected database. Plugs were inserted according to guidance provided by 2 experienced surgeons. Long-term results were determined by clinical visits 3, 6, and 12 months after surgery and once yearly thereafter. Results From 2008 to 2015, 36 fistula plugs were inserted. During the follow-up period with a median duration of 18 months (range, 7–60 months), the fistulae of 52.8% of the patients healed. The plug failure rate was 44.4%, and the fistula recurrence rate was 26.3%. The median time to recurrence was 12 months. The overall success rate for plug treatment in our department was 39% when adjusted for recurrence. Conclusion The use of bioprosthetic plugs to treat patients with complex anal fistulae seems to be a safe, viable option for complex fistula repair when other surgical attempts have failed. However, it should not be the treatment of choice. Further prospective randomized studies with a sufficient sample-size and standardized measurements are necessary to evaluate the efficacy of fistula plugs fully.

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Section: Discussionmentioning

confidence: 88%

Section: Introductionmentioning

confidence: 99%

Efficacy of Plug Treatment for Complex Anorectal Fistulae: Long-term Danish Results

Hansen

Andersen

2019

Ann Coloproctol

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“…After an earlier report of 80% closure rate in 20 patients with Crohn's disease [11], Ellis et al concluded that a history of Crohn's disease is associated with a risk of plug failure [18]. A multicentre study of 126 patients (including 13 patients with Crohn's fistula) reported an overall fistula healing rate of 24% after a median follow‐up of 13 months [2]. However, the results were not stratified for patients with Crohn's disease.…”

Section: Discussionmentioning

confidence: 99%

Long‐term outcome of the Surgisis^® (Biodesign^®) anal fistula plug for complex cryptoglandular and Crohn’s fistulas

et al. 2020

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Aim To evaluate the long‐term success rate of treatment with the Surgisis® (Biodesign®) anal fistula plug for complex anal fistulas, assess fistula plug failure over time and compare success rates for fistula plug between a group of patients with cryptoglandular fistula and another group with Crohn's fistula. Method This is a single‐centre study of consecutive patients treated with the Surgisis® (Biodesign®) anal fistula plug between May 2006 and October 2009. All patients had complex anal fistulas in need of surgical treatment. The patients were assessed preoperatively by physical examination and three‐dimensional (3D) endoanal ultrasound, and treated with a loose seton. Postoperative assessment by clinical examination and 3D endoanal ultrasound was performed at 2 weeks, 3 months and 6–12 months. Long‐term follow‐up was carried out in 2017 using a questionnaire, and clinical examination combined with 3D endoanal ultrasound was performed if the questionnaire indicated any signs of fistula recurrence. Results A total of 95 patients were included; 30 had quiescent Crohn's disease. Overall, 151 plug procedures were performed. Long‐term follow‐up was undertaken in 90 (95%) patients; the results showed that after a median period of 110 months, the overall healing rate after one to five plug procedures was 38%. No statistically significant difference in success rate was found between the cryptoglandular fistula group and the Crohn's fistula group (P = 0.37). No further healing was observed after the use of three plugs. Conclusion Considering its low morbidity in a complex disease with high recurrence rates over time, the anal fistula plug may still be considered as one of the first‐line treatments for patients with complex anal fistulas.

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“…Indeed, early results with the biologic fistula plug were especially promising, with some researchers reporting healing rates of higher than 80%. 12 However, in more recent studies, including randomized controlled trials, 13,14 large, multicenter investigations, 15 and the largest prospective studies, [16][17][18][19] success rates have ranged from 20% to 48%. The wide variation in results with the biologic plug may be due in part to differences in patient populations, study designs, surgical techniques, and follow-up times, 20 although these do not seem to explain the variation completely.…”

Section: Discussionmentioning

confidence: 99%

Prospective Multicenter Study of a Synthetic Bioabsorbable Anal Fistula Plug to Treat Cryptoglandular Transsphincteric Anal Fistulas

Stamos

Snyder

Robb

et al. 2015

Diseases of the Colon &Amp; Rectum

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

Abstract: Four independent patient groups showed low success rates after the first plug-insertion procedure. Anterior fistulae were much less likely to heal compared with fistulae in other locations.

Cited by 16 publications

References 32 publications

Efficacy of Plug Treatment for Complex Anorectal Fistulae: Long-term Danish Results

Efficacy of Plug Treatment for Complex Anorectal Fistulae: Long-term Danish Results

Long‐term outcome of the Surgisis^® (Biodesign^®) anal fistula plug for complex cryptoglandular and Crohn’s fistulas

Prospective Multicenter Study of a Synthetic Bioabsorbable Anal Fistula Plug to Treat Cryptoglandular Transsphincteric Anal Fistulas

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

Abstract: Four independent patient groups showed low success rates after the first plug-insertion procedure. Anterior fistulae were much less likely to heal compared with fistulae in other locations.

Cited by 16 publications

References 32 publications

Efficacy of Plug Treatment for Complex Anorectal Fistulae: Long-term Danish Results

Efficacy of Plug Treatment for Complex Anorectal Fistulae: Long-term Danish Results

Long‐term outcome of the Surgisis® (Biodesign®) anal fistula plug for complex cryptoglandular and Crohn’s fistulas

Prospective Multicenter Study of a Synthetic Bioabsorbable Anal Fistula Plug to Treat Cryptoglandular Transsphincteric Anal Fistulas

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Product

Resources

About

Long‐term outcome of the Surgisis^® (Biodesign^®) anal fistula plug for complex cryptoglandular and Crohn’s fistulas