Efficacy of the anal fistula plug in complex anorectal fistulae.

Objective: The treatment of complex anorectal and rectovaginal fistulae remains a difficult problem. The options are fistulotomy, setons, fibrin glue and a variety of flap procedures. Recently, there have been several reports of a new plug; the Surgisis AFP plug. Reports from various centres do not give consistent results. The aim of this study was to assess the efficacy of the Surgisis AFP fistula plug in a wide spectrum of patients with anorectal, rectovaginal and pouch vaginal fistulae.

Method: Between March 2006 and September 2007, patients with a variety of anal fistulae were selected for fistula plug insertion in the coloproctology units at Leeds, UK, and Aarhus, Denmark. Demographic and fistulae details were obtained. Postoperatively, all patients had a course of oral antibiotics.

Results: Forty-three patients with a median age of 45 (range 18-65) years underwent a total of 45 procedures. Seventy-five per cent (n = 32) had a fistula secondary to cryptoglandular abscess. Median follow up was 47 (range 12-77) weeks. The success rate for complete healing was 44%. Dislodgement caused failure on 10 (22%) occasions.

Conclusion: Our study shows a moderate success rate for treatment with fistula plugs. The complex nature of the fistulae selected may be the reason for the low success rate.