title: Treatment of transsphincteric anal fistulas by endorectal advancement flap or collagen fistula plug: a comparative study.
abstract: OBJECTIVE
  In this study we compared the outcomes of patients with complex cryptoglandular fistulas treated by endorectal advancement flap or anal fistula plug.
  
  
  METHODS
  We performed a retrospective analysis of patients with transsphincteric anal fistulas treated by endorectal advancement flap or anal fistula plug from January 1996 through April 2007. Patients with noncryptoglandular fistulas or insufficient follow-up were excluded. Results were obtained with a combination of chart reviews, mailed questionnaire, and phone interviews. Success was defined as a closed external opening in absence of symptoms at a minimal follow-up time of six months.
  
  
  RESULTS
  Forty-three patients had an endorectal advancement flap and 37 patients had an anal fistula plug procedure. The two cohorts were comparable for age, gender, smoking status, fistula type, and previous failed treatments. The success rate was 63 percent in the endorectal advancement flap group and 32 percent in the anal fistula plug group (P = 0.008), after a mean follow-up of 56 (range, 6-136) months for endorectal advancement flap and 14 (range, 6-22) months for anal fistula plug.
  
  
  CONCLUSIONS
  The current study indicates that the endorectal advancement flap provides a higher success rate than the anal fistula plug. Randomized trials are needed to further elucidate the efficacy and potential functional benefit of the anal fistula plug in the treatment of complex anal fistulas.
authors.affiliation: Division of Colon and Rectal Surgery, Department of Surgery, University of Minnesota Medical School, Minneapolis, USA.
authors.forename: Dimitrios
authors.initials: D
authors.lastname: Christoforidis
authors.forename: Matthew C
authors.initials: MC
authors.lastname: Pieh
authors.forename: Robert D
authors.initials: RD
authors.lastname: Madoff
authors.forename: Anders F
authors.initials: AF
authors.lastname: Mellgren
mesh_terms: D003094:Collagen / Q000008:administration & dosage*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D012003:Rectal Fistula / Q000601:surgery*; D012008:Recurrence; D012086:Reoperation; D013524:Surgical Flaps; D017211:Treatment Failure; D014945:Wound Healing
chemical_list: D003094:Collagen