title: Long-term outcomes of human acellular dermal matrix plug in closure of complex anal fistulas with a single tract.
abstract: BACKGROUND
  Bioprosthetic plugs represent a promising technique for the treatment of anal fistula simple because they allow simple and repeatable application, preservation of sphincter integrity, minimal patient discomfort, and subsequent surgical options if needed. However, success rates vary widely.
  
  
  OBJECTIVE
  The aim of this study was to assess long-term outcome in patients treated with an acellular dermal matrix plug for closure of complex single-tract anal fistulas.
  
  
  METHODS
  This was a retrospective analysis of a prospective database.
  
  
  METHODS
  The study was conducted at a university hospital in Beijing, People's Republic of China.
  
  
  METHODS
  The study population comprised 114 patients treated between January 2007 and May 2010 for complex high transsphincteric anal fistula with a single tract.
  
  
  METHODS
  Fistulas were treated with an acellular dermal matrix plug derived from donated human skin.
  
  
  METHODS
  The main outcome measures were fistula closure rate and postoperative incontinence (Wexner scores).
  
  
  RESULTS
  No mortality or major complications were observed. The overall success rate was 54.4% (62/114), with a median follow-up of 19.5 (range, 11-46) months. Of the 52 patients with plug failure, 11 (21%) had plug extrusion and 9 (17%) had sepsis. Most plug failures occurred within 30 days, with only 1 plug failure occurring 6 months after surgery. On multiple logistic regression analysis, smoking (P < .001), long distance between external opening (P < .001), and performance of the operation by a nonexpert surgeon (P = .018) were significantly associated with plug failure. Of 40 patients who underwent cutting seton placement after plug failure, 33 (82.5%) reported a successful outcome. However, the rate of incontinence 6 months after seton placement was 75% (30/40), whereas the rate in the overall study population 6 months after insertion of the ADM plug was 1.75% (2/114; P < .001).
  
  
  CONCLUSIONS
  This study was limited by its retrospective nature.
  
  
  CONCLUSIONS
  Given the low morbidity and relative simplicity of the procedure, we suggest that an acellular dermal matrix plug is a reasonable option for closure of complex anal fistulas with a single tract.
authors: Department of General Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing, People's Republic of China.
authors: Jia Gang
authors: JG
authors: Han
authors: Zhen Jun
authors: ZJ
authors: Wang
authors: Bao Cheng
authors: BC
authors: Zhao
authors: Yi
authors: Y
authors: Zheng
authors: Bo
authors: B
authors: Zhao
authors: Bing Qiang
authors: BQ
authors: Yi
authors: Xin Qing
authors: XQ
authors: Yang
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002681:China; D020405:Dermis / Q000637:transplantation*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D012003:Rectal Fistula / Q000473:pathology / Q000601:surgery*; D012008:Recurrence; D012189:Retrospective Studies; D013630:Tampons, Surgical; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult