title: Anal fistula plug: a prospective evaluation of success, continence and quality of life in the treatment of complex fistulae.
abstract: OBJECTIVE
  Curing complex anal fistula without compromising continence can be extremely challenging. This study investigated the healing rate, continence and quality of life of patients after treatment of complex anal fistula of cryptoglandular origin with a bioprosthetic plug.
  
  
  METHODS
  Consecutive patients were prospectively followed in four referral centres. Following seton conditioning, a bioprosthetic plug was inserted into the fistula and sutured to the anal sphincter. Clinical evaluation was performed at 10 days, 6 weeks and 6 months after surgery, and was completed by telephone interviews. Anal continence and quality of life were evaluated using the Fecal Incontinence Score Index and the Short Form-36 Health Survey, version 2 (SF-36 v2) questionnaire.
  
  
  RESULTS
  Forty-six patients presenting with a complex anal fistula and a median of three previous fistula surgeries were included. The 6-month recurrence rate was 30.7% (95% CI: 15.9-42.8%), increasing to 48.0% (95% CI: 30.6-61.1%) after 2 years. Follow up was continued for a median of 68.1 months, and 26 (56.5%) recurrences were identified. Anal continence improved from a median of 19 points to 12 points at 6 months of follow up (P = 0.008). Quality of life markedly improved in all scales. The physical summary score increased from 47.2 to 56.2 (P < 0.001), and the mental summary score increased from 48.5 to 55.3 (P = 0.013).
  
  
  CONCLUSIONS
  The bioprosthetic fistula plug demonstrated a healing rate close to 50% in complex cryptoglandular fistula. Also, it markedly improved anal continence and quality of life. These data support the use of a bioprosthetic plug as first-line therapy for complex fistula instead of more aggressive and potentially debilitating surgical options.
authors: Department of Surgery, Kantonsspital St. Gallen, St. Gallen, Switzerland; Department of Surgery, Women's College Hospital, Toronto, ON, Canada; Department of Surgery, Mount Sinai Hospital, Toronto, ON, Canada; Department of Surgery, St Michael's Hospital, Toronto, ON, Canada.
authors: M
authors: M
authors: Adamina
authors: T
authors: T
authors: Ross
authors: M O
authors: MO
authors: Guenin
authors: R
authors: R
authors: Warschkow
authors: C
authors: C
authors: Rodger
authors: Z
authors: Z
authors: Cohen
authors: M
authors: M
authors: Burnstein
mesh_terms: D000328:Adult; D001705:Bioprosthesis; D013505:Digestive System Surgical Procedures / Q000379:methods*; D005242:Fecal Incontinence / Q000601:surgery*; D005260:Female; D006305:Health Status Indicators; D006801:Humans; D008026:Ligation; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction; D011446:Prospective Studies; D011788:Quality of Life; D012003:Rectal Fistula / Q000601:surgery*
keywords: Complex anal fistula, bioprosthetic plug, anal continence, quality of life