title: Anal fistula plug is a valid alternative option for the treatment of complex anal fistula in the long term.
abstract: OBJECTIVE
  This prospective, two-centre study was designed to evaluate long-term outcomes when using a collagen plug to treat cryptoglandular anal fistulae.
  
  
  METHODS
  Over 3 years, 60 consecutive patients with cryptoglandular fistulae were treated using an anal fistula plug by experienced surgeons. Preoperative, postoperative and follow-up data were collected in a dedicated database. Success was defined as the closure of all fistula openings and the absence of discharge. Faecal incontinence scores were administered at baseline and at 6 months follow-up.
  
  
  RESULTS
  Eleven patients had multiple fistula tracts. All fistulae treated in this series were classified as complex. Seventeen fistulae were anterior tracts in females, and the remaining tracts were trans-sphincteric in nature. Thirty-eight tracts were recurrent. Mean operative time was 26 ± 10 min. No major complications, active sepsis or mortality were observed. Success rate with a mean follow-up of 13 months was 60% of patients and 70% of tracts. Mean time for recurrence was 5.7 months. Two recurrent patients were successfully treated with a redo plug procedure, and five were successfully closed with a post-plug fistulotomy, leading to a global 72% success rate without continence impairment. Of the patients with a minimum follow-up of 6 months (mean, 18.5 months; range, 6-34 months), 29 in 32 (90.6%) were healed at final evaluation. In these patients, the mean preoperative CCF incontinence score was 0.73. This was reduced to 0.14 at 6-month follow-up. The mean reduction of CCF incontinence score was -0.6 (95% CI, 1.3 to -0.1; p = 0.01).
  
  
  CONCLUSIONS
  Fistula tract treatment with the anal fistula plug is a safe and viable surgical option that should be offered to complex fistula patients. The reasons and risk factors for recurrence remain to be explored.
authors.affiliation: Surgery Unit, Casa di Cura San Pio X, Via Francesco Nava, 31, 20159, Milan, Italy. leonardo_lenisa@lycos.com
authors.forename: Leonardo
authors.initials: L
authors.lastname: Lenisa
authors.forename: Eloy
authors.initials: E
authors.lastname: Espìn-Basany
authors.forename: Andrea
authors.initials: A
authors.lastname: Rusconi
authors.forename: Luigi
authors.initials: L
authors.lastname: Mascheroni
authors.forename: Jordi
authors.initials: J
authors.lastname: Escoll-Rufino
authors.forename: Roberto
authors.initials: R
authors.lastname: Lozoya-Trujillo
authors.forename: Francesc
authors.initials: F
authors.lastname: Vallribera-Valls
authors.forename: Jacques
authors.initials: J
authors.lastname: Mégevand
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D003094:Collagen / Q000627:therapeutic use; D013505:Digestive System Surgical Procedures / Q000295:instrumentation / Q000379:methods*; D005242:Fecal Incontinence / Q000209:etiology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011184:Postoperative Period; D012003:Rectal Fistula / Q000150:complications / Q000601:surgery*; D012008:Recurrence; D013525:Surgical Instruments; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D003094:Collagen