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Treatment of Complex Anal Fistulas with the Collagen Fistula Plug

  • Original Contribution
  • Published:
Diseases of the Colon & Rectum

Abstract

Purpose

Anal fistulas that involve a significant amount of sphincter may be difficult to treat without compromising continence function. In this study, we evaluated our experience with the Surgisis® anal fistula plug, which was recently reported to be successful in >80 percent of patients with complex fistulas.

Methods

We retrospectively collected patient and fistula characteristics, procedure details, and follow-up information for all patients treated with the anal fistula plug at our institution from January 2006 through April 2007. The outcome was considered successful if the external opening was closed and if the patient had no drainage at the last follow-up. Using multivariate statistics, we analyzed the relationship between anal fistula plug success and several key variables.

Results

From January 2006 through April 2007, 47 patients with 49 complex anal fistulas underwent 64 anal fistula plug procedures. The median follow-up time for patients who were considered healed was 6.5 (range, 3–11) months. The success rate was 31 percent per procedure and 43 percent per patient. An increased amount of external sphincter involvement was associated with a higher failure rate (P < 0.05).

Conclusions

In our early experience with the anal fistula plug, 43 percent of patients with complex anal fistulas were successfully treated. Patients with less external sphincter involvement were more likely to heal.

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References

  1. Sonoda T, Hull T, Piedmonte MR, Fazio VW. Outcomes of primary repair of anorectal and rectovaginal fistulas using the endorectal advancement flap. Dis Colon Rectum 2002;45:1622–8.

    Article  PubMed  Google Scholar 

  2. Schouten WR, Zimmerman DD, Briel JW. Transanal advancement flap repair of transsphincteric fistulas. Dis Colon Rectum 1999;42:1419–22.

    Article  PubMed  CAS  Google Scholar 

  3. Ortíz H, Marzo J. Endorectal flap advancement repair and fistulectomy for high trans-sphincteric and suprasphincteric fistulas. Br J Surg 2000;87:1680–3.

    Article  PubMed  Google Scholar 

  4. Mizrahi N, Wexner SD, Zmora O, et al. Endorectal advancement flap: are there predictors of failure? Dis Colon Rectum 2002;45:1616–21.

    Article  PubMed  Google Scholar 

  5. Ellis CN, Clark S. Fibrin glue as an adjunct to flap repair of anal fistulas: a randomized, controlled study. Dis Colon Rectum 2006;49:1736–40.

    Article  PubMed  Google Scholar 

  6. Gustafsson UM, Graf W. Randomized clinical trial of local gentamicin-collagen treatment in advancement flap repair for anal fistula. Br J Surg 2006;93:1202–7.

    Article  PubMed  CAS  Google Scholar 

  7. Hämäläinen KP, Sainio AP. Cutting seton for anal fistulas: high risk of minor control defects. Dis Colon Rectum 1997;40:1443–6.

    Article  PubMed  Google Scholar 

  8. García-Aguilar J, Belmonte C, Wong DW, Goldberg SM, Madoff RD. Cutting seton versus two-stage seton fistulotomy in the surgical management of high anal fistula. Br J Surg 1998;85:243–5.

    Article  PubMed  Google Scholar 

  9. Isbister WH, Al Sanea N. The cutting seton: an experience at King Faisal Specialist Hospital. Dis Colon Rectum 2001;44:722–7.

    Article  PubMed  CAS  Google Scholar 

  10. Zmora O, Mizrahi N, Rotholtz N, et al. Fibrin glue sealing in the treatment of perineal fistulas. Dis Colon Rectum 2003;46:584–9.

    Article  PubMed  Google Scholar 

  11. Loungnarath R, Dietz DW, Mutch MG, Birnbaum EH, Kodner IJ, Fleshman JW. Fibrin glue treatment of complex anal fistulas has low success rate. Dis Colon Rectum 2004;47:432–6.

    Article  PubMed  Google Scholar 

  12. Robb BW, Vogler SA, Nussbaum MN, Sklow B. Early experience using porcine small intestinal submucosa to repair fistulas-in-ano. Dis Colon Rectum 2004;47:565–660.

    Article  Google Scholar 

  13. Champagne BJ, O’Connor LM, Ferguson M, Orangio GR, Schertzer ME, Armstrong DN. Efficacy of anal fistula plug in closure of cryptoglandular fistulas: long-term follow-up. Dis Colon Rectum 2006;49:1817–21.

    Article  PubMed  Google Scholar 

  14. O’Connor L, Champagne BJ, Ferguson MA, Orangio GR, Schertzer ME, Armstrong DN. Efficacy of anal fistula plug in closure of Crohn’s anorectal fistulas. Dis Colon Rectum 2006;49:1569–73.

    Article  PubMed  Google Scholar 

  15. Ellis CN. Bioprosthetic plugs for complex anal fistulas: an early experience. J Surg Educ 2007;64:36–40.

    Article  PubMed  Google Scholar 

  16. van Koperen PJ, D’Hoore A, Wolthuis AM, Bemelman WA, Slors JF. Anal fistula plug for closure of difficult anorectal fistula: a prospective study. Dis Colon Rectum 2007;50:2168–72.

    Article  PubMed  Google Scholar 

  17. Ky AJ, Sylla S, Kim A, Steinhagen RM. Short-term results in the treatment of anal fistulas with Surgisis AFP meeting abstract. Dis Colon Rectum 2007;50:725.

    Google Scholar 

  18. Poirier M, Cintron JR, Nelson RL, Prasad ML, Abcarian H. Surgisis AFP: a changing paradigm in the treatment of fistula-in-ano meeting abstract? Dis Colon Rectum 2006;49:770.

    Google Scholar 

  19. Abbas MA, Lawes D, Heppel J, et al. Anal fistula plug (AFP) for the treatment of fistula-in-ano meeting abstract. Dis Colon Rectum 2007;50:749.

    Google Scholar 

  20. Safar B, Jobanputra S, Cera S, et al. Anal fistula plug: Initial experience and outcomes meeting abstract. Dis Colon Rectum 2007;50:725.

    Google Scholar 

  21. Bohe M, Starck M, Zawadzki A. The results of the anal fistula plug for high transsphincteric fistula meeting abstract. Colorectal Dis 2007;9:7.

    Google Scholar 

  22. Lenisa L, Rusconi A, Mascheroni L, Andreoli M, Grignani R, Megevand J. Obliterative treatment for cryptoglandular fistula with anal plug. Does it work in Europe meeting abstract? Colorectal Dis 2007;9:54.

    Article  Google Scholar 

  23. Schwandner T, Roblick M, Padberg W. Therapy of the complex transsphincteric fistula with a fistula plug: first results meeting abstract. Colorectal Dis 2007;9:58.

    Google Scholar 

  24. Thekkinkattil D, Gonsalves S, Burke D, et al. Efficacy of anal fistula plug in closure of recurrent anorectal fistulae meeting abstract. Colorectal Dis 2007;9:59.

    Google Scholar 

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Acknowledgment

The authors thank Mary Knatterud, Ph.D., for assistance.

Author information

Authors and Affiliations

  1. Division of Colon and Rectal Surgery, Department of Surgery, University of Minnesota Medical School, Minneapolis, Minnesota, USA

    Dimitrios Christoforidis M.D., David A. Etzioni M.D., M.S.H.S., Stanley M. Goldberg M.D., Robert D. Madoff M.D. & Anders Mellgren M.D., Ph.D.

  2. Department of Colon and Rectal Surgery, University of Southern California, Los Angeles, California, USA

    David A. Etzioni M.D., M.S.H.S.

Authors
  1. Dimitrios Christoforidis M.D.
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  2. David A. Etzioni M.D., M.S.H.S.
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  3. Stanley M. Goldberg M.D.
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  4. Robert D. Madoff M.D.
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  5. Anders Mellgren M.D., Ph.D.
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Corresponding author

Correspondence to Dimitrios Christoforidis M.D..

Additional information

Dr. Christoforidis’ research fellowship was supported by grants from the SICPA foundation, Lausanne, Switzerland, the Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland and the Minnesota Colon & Rectal Foundation.

Dr. Anders Mellgren received an honorarium for research consulting (two meetings) from Cook Medical. He receives research support and does consulting for American Medical Systems, Ethicon Endosurgery, and Q-med Scandinavia. Dr. Mellgren receives research support from Medtronic.

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Christoforidis, D., Etzioni, D.A., Goldberg, S.M. et al. Treatment of Complex Anal Fistulas with the Collagen Fistula Plug. Dis Colon Rectum 51, 1482–1487 (2008). https://doi.org/10.1007/s10350-008-9374-5

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  • DOI: https://doi.org/10.1007/s10350-008-9374-5

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