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Effects of an anal fistula plug on anal function after surgery for treatment of a trans-sphincteric anal fistula

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Abstract

Purpose

The aim of this study was to evaluate the anal function in patients with trans-sphincteric anal fistulas who underwent an anal fistula plug procedure, and analyze risk factors that might affect post-operative anal function.

Methods

This was an observational, retrospective study of patients diagnosed with trans-sphincteric anal fistulas and initially underwent anal fistula plug procedures between August 2008 and September 2012 at our institute. The analysis includes clinical characteristics, anal fistula healing, and the Wexner score for pre- and post-operative anal function (0 = no incontinence to 20 = complete incontinence).

Results

A total of 123 patients who had an adequate follow-up in the end were included. The median duration of follow-up was 8 years (range 72–121 months). The overall healing rate was 56% (69/123), and 33 (26.8%) patients had decreased anal function after surgery. The post-operative Wexner score on anal function was significantly higher than that before the operation (p < 0.001), as well as scores of gas, liquid stool, solid stool incontinence, and alteration in lifestyle (p < 0.05). Based on multiple logistic regression analysis, a high body mass index (p < 0.001) and long distance between the external opening and anal verge (p = 0.003) were significantly associated with a decline in post-operative anal function.

Conclusions

As a sphincter-preserving technique for the treatment of anal fistulas, the anal fistula plug procedure might impair the anal function. Especially for patients with obesity or long distance between the external opening of anal fistula and anal verge, the reduced anal function is more likely to occur after treatment with anal fistula plug therapy.

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Data availability

All datasets generated or analyzed during this study are included in this published article.

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Funding

National Natural Science Foundation of China (82070685), The Capital Health Research and Development of Special (2018-1-2032), Project of Beijing Chaoyang Hospital 1351 talents training (CYXZ-2017-09), Beijing Municipal Administration of Hospitals incubating Program (PX2019012), and the Scientific Research and Cultivation Fund of Capital Medical University.

Author information

Author notes

  1. Yu Tao, and Yi Zheng contributed equally to this work and considered as co-first authors

Authors and Affiliations

  1. Department of General Surgery, Beijing Chaoyang Hospital, Capital Medical University, No. 8 Gongtinan Road, Chaoyang District, Beijing, 100020, People’s Republic of China

    Yu Tao, Yi Zheng, Jia Gang Han, Zhen Jun Wang, Jin Jie Cui, Bao Cheng Zhao & Xin Qing Yang

Authors
  1. Yu Tao
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  2. Yi Zheng
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  3. Jia Gang Han
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  5. Jin Jie Cui
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  6. Bao Cheng Zhao
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  7. Xin Qing Yang
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Contributions

Study conception and design: Tao, Zheng, Han, Wang, Cui, Zhao, Yang; acquisition of data: Tao, Zheng, Han, Wang, Cui, Zhao, Yang; analysis and interpretation of data: Tao, Zheng, Han, Wang; drafting of manuscript: Tao, Zheng, Han, Wang, Cui, Zhao, Yang; critical revision of manuscript: Tao, Zheng, Han, Wang.

Corresponding authors

Correspondence to Jia Gang Han or Zhen Jun Wang.

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Conflict of interest

The authors declare that they have no conflict of interest.

Ethics approval and consent to participate

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. This study was approved by the Ethics Committee of Beijing Chaoyang Hospital, Capital Medical University, Beijing, China (the reference number: 2019-ke-286). All enrolled patients gave informed consent for use of their data in this study.

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Oral poster presentation at the meeting of American Society of Colon and Rectal Surgeons, Boston, MA, June 06 to 10, 2020.

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Tao, Y., Zheng, Y., Han, J.G. et al. Effects of an anal fistula plug on anal function after surgery for treatment of a trans-sphincteric anal fistula. Langenbecks Arch Surg 406, 855–861 (2021). https://doi.org/10.1007/s00423-020-02024-5

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  • DOI: https://doi.org/10.1007/s00423-020-02024-5

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