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Analfistelplug

Anal fistula plug

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coloproctology Aims and scope

Zusammenfassung

Fragestellung

Der Fistelplug wurde als neues Verfahren zur Behandlung hoher Analfisteln eingeführt. Ziel dieses Reviews ist die Darstellung und Auswertung der derzeit vorliegenden Literatur.

Methodik

Das Review beruht auf einer umfangreichen Recherche der zugänglichen Literatur unter Nutzung von PubMed und unter Einschluss deutschsprachiger Arbeiten.

Ergebnisse

Es konnten insgesamt 36 Publikationen identifiziert werden, die Ergebnisse für die derzeit in Deutschland eingesetzten Plugs der Firmen Cook und Gore bieten. Weiterhin wurden 2 englischsprachige Reviews ausgewertet. Die Literatur mit Ergebnissen für den Fistelplug ist sehr heterogen mit Heilungsraten zwischen 14 und über 90%. Randomisierte Studien berichten für den Biodesign-Plug (vormals „Surgisis-Plug“) Heilungsraten von 20 bzw. 29%. Kontinenzstörungen nach der Plugimplantation werden nur selten untersucht, scheinen jedoch selten zu sein. Ein Problem stellt der Plugverlust mit Persistieren der Fistel dar. Neuere Plugmodelle können diesen Nachteil möglicherweise durch eine bessere Verankerungsmöglichkeit ausgleichen. Verlässliche Daten liegen derzeit aber noch nicht vor.

Schlussfolgerung

Die derzeitige Literatur lässt nur eingeschränkte Schlussfolgerungen für den Plug zu. Trotz der niedrigeren Erfolgsrate scheint er wegen seiner geringeren Invasivität eine Alternative zu den herkömmlichen Verfahren bei hohen Analfisteln darzustellen.

Abstract

Background

The anal fistula plug has been introduced as a new procedure for the treatment of high anal fistulas. The aim of this review is to demonstrate and evaluate the current literature.

Methods

This publication is based on a systematic review of the available English and German publications.

Results

A total of 36 relevant publications were identified which present results of the two plugs used in Germany from Cook and Gore, respectively. Also two reviews in the English language were evaluated. Results concerning the fistula plug procedure are quite heterogeneous showing healing rates ranging from 14% to more than 90%. Two randomized studies reported a success rate of 20% and 29%, respectively for the Biodesign Plug formerly known as the Surgisis-Plug.Continence disorders after plug implantation were evaluated only in a few studies and newly developed disorders seem to be rare. Loss of the plug in the early postoperative period seems to be a problem. New plug models may balance this disadvantage by a better fixation of the plug to the underlying muscle. Currently there are no reproducible results for this new plug design.

Conclusion

The results presented in the current literature allow only limited conclusions to be drawn for the plug procedure. In spite of the low success rate the plug seems to be an alternative to conventional treatment for high anal fistulas due to the lower invasiveness of the procedure.

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Interessenskonflikt

Der korrespondierende Autor weist für sich und seine Koautoren auf folgende Beziehungen hin: Dr. Ommer erhielt Honorare von der DGAV für die Erstellung von drei Leitlinien zum Thema Analfisteln. Des Weiteren erhielt er Erstattung von Reise- und Übernachtungskosten von den Firmen Gore und Johnson&Johnson. Vorträge auf Fortbildungsveranstaltungen wurden von den Firmen Kade und MSD honoriert. Prof. Herold erhielt finanzielle Unterstützung für Kongresse von Falk-Foundation, Johnson&Johnson, Prostrakan, MSD und Aesculap. Weitere Vorhaben wurden durch Drittmittel folgender Firmen unterstützt: Cook, Gore, SLA-Pharma, Falk-Foundation, Kreussler. Prof. Sailer erhielt Honorare für Fortbildungsveranstaltungen von Covidien, Johnson & Johnson, Falk-Foundation sowie Hitachi Medical.

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Authors and Affiliations

  1. End- und Dickdarmpraxis Essen, Rüttenscheider Str. 66, 45130, Essen, Deutschland

    A. Ommer

  2. End- und Dickdarmzentrum Mannheim, Mannheim, Deutschland

    A. Herold

  3. Bethesda-Krankenhaus Hamburg-Bergdorf, Hamburg-Bergdorf, Deutschland

    M. Sailer

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  1. A. Ommer
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  2. A. Herold
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  3. M. Sailer
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Correspondence to A. Ommer.

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Ommer, A., Herold, A. & Sailer, M. Analfistelplug. coloproctology 34, 341–351 (2012). https://doi.org/10.1007/s00053-012-0312-6

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  • DOI: https://doi.org/10.1007/s00053-012-0312-6

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