title: Initial experience of treating anal fistula with the Surgisis anal fistula plug.
abstract: BACKGROUND
  Complex anal fistulas remain a challenge for the colorectal surgeon. The anal fistula plug has been developed as a simple treatment for fistula-in-ano. We present and evaluate our experience with the Surgisis anal fistula plug from two centres.
  
  
  METHODS
  Data were prospectively collected and analysed from consecutive patients undergoing insertion of a fistula plug between January 2007 and October 2009. Fistula plugs were inserted according to a standard protocol. Data collected included patient demographics, fistula characteristics and postoperative outcome.
  
  
  RESULTS
  Forty-four patients underwent insertion of 62 plugs (27 males, mean age 45.6 years), 25 of whom had prior fistula surgery. Mean follow-up was 10.5 months Twenty-two patients (50%) had successful healing following the insertion of plug with an overall success rate of 23 out of 62 plugs inserted (35%). Nineteen out of 29 patients healed following first-time plug placement, whereas repeated plug placement was successful in 3 out of 15 patients (20%; p = 0.0097). There was a statistically significant difference in the healing rate between patients who had one or less operations prior to plug insertion (i.e. simple fistulas) compared with patients who needed multiple operations (18 out of 24 patients vs. 4 out of 20 patients; p = 0.0007).
  
  
  CONCLUSIONS
  Success of treatment with the Surgisis anal fistula plug relies on the eradication of sepsis prior to plug placement. Plugs inserted into simple tracts have a higher success rate, and recurrent insertion of plugs following previous plug failure is less likely to be successful. We suggest the fistula plug should remain a first-line treatment for primary surgery and simple tracts.
authors.affiliation: Department of Colorectal Surgery, University College Hospital, London, UK.
authors.forename: S
authors.initials: S
authors.lastname: Chan
authors.forename: J
authors.initials: J
authors.lastname: McCullough
authors.forename: A
authors.initials: A
authors.lastname: Schizas
authors.forename: P
authors.initials: P
authors.lastname: Vasas
authors.forename: A
authors.initials: A
authors.lastname: Engledow
authors.forename: A
authors.initials: A
authors.lastname: Windsor
authors.forename: A
authors.initials: A
authors.lastname: Williams
authors.forename: C R
authors.initials: CR
authors.lastname: Cohen
mesh_terms: D000328:Adult; D000368:Aged; D001705:Bioprosthesis; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012003:Rectal Fistula / Q000000981:diagnostic imaging / Q000601:surgery*; D013525:Surgical Instruments; D016896:Treatment Outcome; D014463:Ultrasonography; D055815:Young Adult