Plugs unplugged. Anal fistula plug: the Concord experience

Purpose: The purpose of this study was to analyse preliminary experience and outcomes with the Cook Surgisis AFP (TM) anal fistula plug (Cook Medical, Bloomington, IN, USA) with respect to the treatment of complex anal fistulae in a specialist colorectal unit. Methods: Data on all patients who were treated with the Surgisis AFP (TM) between October 2006 and January 2009 were retrospectively reviewed. The plug was placed in accordance with the Cook guidelines. Successful closure of the anal fistula was defined as absence of drainage at final follow-up with no subsequent abscess formation or further intervention required. Results: Thirty-two patients underwent a total of 35 anal fistula plug insertion procedures. No patients were lost to follow-up. The median follow-up was 15 months (2-29 months). The overall success rate was 13 out of 35 (37%). For those in the subgroups of Crohn's disease and cryptoglandular disease, the success rate was 1 out of 3 (33%) and 11 out of 31 (35%), respectively. Conclusion: This series demonstrates a success rate for the Cook Surgisis AFP (TM) of 37%. These results in patients managed in a specialist unit confirm that the Surgisis AFP (TM) is a useful option in the management of complex fistulae.