Acceptable results using plug for the treatment of complex anal fistulas.

Abstract

Introduction: The management of complex fistula-in-ano remains a surgical challenge. Previously published studies on the treatment of fistula-in-ano with the anal fistula plug (AFP) have reported a success rate reaching 35-87%. The aim of this study was to assess the results of the AFP procedure in a group of Danish patients with complex fistulas, and to analyse if the results were compatible with previous international findings.

Material and methods: A retrospective analysis of prospectively collected data was performed for 37 consecutive patients treated with the Surgisis AFP plug for complex fistula-in-ano at the Surgical Department of Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark, between June 2006 and April 2010. Surgery and evaluation were performed by one of two specially trained proctologists.

Results: The success rate per patient was 45.9% (17/37) and the success rate per procedure was 44.7% (17/38). A total of 40 fistulas were treated with the AFP and the success rate per fistula was 47.5% (19/40). Plug dislodgement occurred after 28.9% of the procedures, thereby accounting for 52.4% of the failed AFP procedures (11/38). No patients experienced any change in continence after the procedure.

Conclusion: We found a patient cure rate of 45.9% which is in accordance with previously reported patient cure rates of 35-87%. Current knowledge suggests that the AFP is a good choice for first-line management of complex fistula-in-ano, but further evaluation is needed.