title: Evaluation of a new synthetic plug in the treatment of anal fistulas: results of a pilot study.
abstract: BACKGROUND
  The treatment of anal fistulas using plugs is a very promising method because of its simplicity and ability to be carried out on an ambulatory basis. If unsuccessful, it does not compromise subsequent alternative surgical techniques and/or products. However, success rates are variable.
  
  
  OBJECTIVE
  This pilot study was designed to investigate the safety and effectiveness of a new synthetic plug in the treatment of transsphincteric anal fistulas.
  
  
  METHODS
  This was a prospective observational study.
  
  
  METHODS
  Patients were treated at 2 colorectal surgery centers in Spain (Seville and Huelva).
  
  
  METHODS
  Anal fistulas were treated with a fistula plug made of bioabsorbable polymers (67% polyglycolide, 33% trimethylene carbonate).
  
  
  METHODS
  Starting in January 2009, consecutive adult patients with transsphincteric anal fistulas were evaluated.
  
  
  METHODS
  Outcome measures included rates of successful fistula closure, complications, and continence (Jorge-Wexner incontinence score), assessed postoperatively at 1 week and again at 1, 3, 6, and 12 months. Healing was determined by clinical examination by a surgeon blinded for the intervention.
  
  
  RESULTS
  A total of 19 patients (18 men, 1 woman) with transsphincteric anal fistulas were included in the study. The median age was 49 (range, 33-65) years. Of these patients, 12 presented with fistula relapse. The median time from onset of symptoms to surgery was 12 (range, 6-120) months. Three patients had previously placed setons. The follow-up duration was 12 months. Relapse occurred in 16 patients (with a perianal abscess in 1), and successful closure was observed in 3 patients (15.8%).
  
  
  CONCLUSIONS
  The number of patients was small, and time was needed for the learning curve of the technique.
  
  
  CONCLUSIONS
  This study indicates that the new synthetic plug is safe, but the fistula closure rate was low. Randomized studies are needed to further determine the role of the bioabsorbable synthetic plug in the management of anal fistulas.
authors: Coloproctology Unit, University Hospital Virgen del Rocio, Seville, Spain. delaportilla@ucpsevilla.es
authors: Fernando
authors: F
authors: de la Portilla
authors: Ricardo
authors: R
authors: Rada
authors: Rosa
authors: R
authors: Jiménez-Rodríguez
authors: José Manuel
authors: JM
authors: Díaz-Pavón
authors: José M
authors: JM
authors: Sánchez-Gil
mesh_terms: D000328:Adult; D000368:Aged; D015331:Cohort Studies; D004146:Dioxanes / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D011100:Polyglycolic Acid / Q000627:therapeutic use*; D012003:Rectal Fistula / Q000473:pathology / Q000601:surgery*; D012008:Recurrence; D013630:Tampons, Surgical; D016896:Treatment Outcome
chemical_list: D004146:Dioxanes; D011100:Polyglycolic Acid; C443643:trimethylene carbonate