title: Anal fistula plug and fibrin glue versus conventional treatment in repair of complex anal fistulas.
abstract: BACKGROUND
  High transsphincteric fistulas are difficult to treat because fistulotomy of involved sphincter muscle results in incontinence. We compare our outcomes for anal fistula plug, fibrin glue, advancement flap closure, and seton drain insertion.
  
  
  METHODS
  This is a retrospective study of patients treated for high transsphincteric anal fistulas. The primary outcome was full healing at 12 weeks postoperatively.
  
  
  RESULTS
  Between 1997 and 2008, 232 patients with anal fistula were identified in the St. Paul's Hospital Anal Fistula Database. Postoperative healing rates at the 12-week follow-up for the fistula plug, fibrin glue, flap advancement, and seton drain groups were 59.3%, 39.1%, 60.4%, and 32.6%, respectively (P < .0001).
  
  
  CONCLUSIONS
  Closure of the primary fistula opening using a biological anal fistula plug and anal flap advancement result in similar fistula healing rates in patients with high transsphincteric fistulae. These 2 strategies are superior to seton placement and fibrin glue. Given the low morbidity and relative simplicity of the procedure, the anal fistula plug is a viable alternative treatment for patients with high transsphincteric anal fistulas.
authors.affiliation: Division of General Surgery, St Paul's Hospital, University of British Columbia, Vancouver, BC, Canada.
authors.forename: Wiley
authors.initials: W
authors.lastname: Chung
authors.forename: Pooya
authors.initials: P
authors.lastname: Kazemi
authors.forename: David
authors.initials: D
authors.lastname: Ko
authors.forename: Clare
authors.initials: C
authors.lastname: Sun
authors.forename: Carl J
authors.initials: CJ
authors.lastname: Brown
authors.forename: Manoj
authors.initials: M
authors.lastname: Raval
authors.forename: Terry
authors.initials: T
authors.lastname: Phang
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004322:Drainage; D005260:Female; D015718:Fibrin Tissue Adhesive / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012003:Rectal Fistula / Q000145:classification / Q000601:surgery*; D012189:Retrospective Studies; D013524:Surgical Flaps; D014014:Tissue Adhesives / Q000627:therapeutic use*; D014945:Wound Healing; D055815:Young Adult
chemical_list: D015718:Fibrin Tissue Adhesive; D014014:Tissue Adhesives