To determine the efficacy of anal fistula plug in the treatment of high fistula-in-ano: an initial experience

Objective The aim of this study was to determine the efficacy of the anal fistula plug in the treatment of high fistula-in-ano. Method Twenty-three patients with high cryptoglandular fistula-in-ano were prospectively studied over 1 year. The number of tracks, number of previous procedures and co-morbid conditions that could potentially affect outcome were noted. A seton was used to guide the AFP (TM) into the fistula track which was anchored at the primary opening. Results Two patients were lost to follow-up. Twenty-one patients (mean age was 49.8 years) were followed from 192 to 543 days (median = 292 days). Thirteen patients had single track, eight had multiple tracks and 14 had a recurrent fistula. Success, defined by closure of all fistula tracks occurred in 71.4% (15/21). The success rate was 84.6% in patients with a single fistula track (11/13) compared with 50% in patients with multiple tracks (4/8) (P = 0.14, Fisher's exact test). Recurrent [10/14 (71.4%)] vs nonrecurrent fistulae [5/7 (71.4%)] had no bearing on the outcome (P = 1.0). Two patients experienced healing despite extrusion of the plug in the early postoperative period. The procedure was safe and well tolerated. Conclusion The Surgisis (R) AFP (TM) was successful in 71.4% of patients. Plug extrusion does not necessarily mean failure.