Anal fistula plug is a valid alternative option for the treatment of complex anal fistula in the long term

Objective This prospective, two-centre study was designed to evaluate long-term outcomes when using a collagen plug to treat cryptoglandular anal fistulae Materials and method Over 3 years, 60 consecutive patients with cryptoglandular fistulae were treated using an anal fistula plug by experienced surgeons Preoperative, postoperative and follow-up data were collected in a dedicated database Success was defined as the closure of all fistula openings and the absence of discharge Faecal incontinence scores were administered at baseline and at 6 months follow-up Results Eleven patients had multiple fistula tracts All fistulae treated in this series were classified as complex Seventeen fistulae were anterior tracts in females, and the remaining tracts were trans-sphincteric in nature Thirty-eight tracts were recurrent Mean operative time was 26 +/- 10 min No major complications, active sepsis or mortality were observed Success rate with a mean follow-up of 13 months was 60% of patients and 70% of tracts Mean time for recurrence was 5 7 months Two recurrent patients were successfully treated with a redo plug procedure, and five were successfully closed with a post-plug fistulotomy, leading to a global 72% success rate without continence impairment Of the patients with a minimum follow-up of 6 months (mean, 18 5 months, range, 6-34 months), 29 in 32 (90 6%) were healed at final evaluation In these patients, the mean preoperative CCF incontinence score was 0 73 This was reduced to 0 14 at 6-month follow-up The mean reduction of CCF incontinence score was -0 6 (95% CI, 13 to -0 1, p = 0 01) Conclusion Fistula tract treatment with the anal fistula plug is a safe and viable surgical option that should be offered to complex fistula patients The reasons and risk factors for recurrence remain to be explored