Initial experience with collagen plug for the treatment of complex anal fistula

Introduction: Anorectal fistulas are a communication between the anal canal or the rectum to the perineum, which are generally formed by an infectious process of the sub-mucosal glands. Surgery is the treatment of choice for these fistulas with preservation of the anal sphincters function, and hence continence, mandatory. Recently, however, some articles published suggested that the use of anal fistula plugs, instead of surgery, leads to better results. This study was designed to evaluate the use of anal fistula plugs in patients with trans-sphincteric anal fistulas. Methods: A series of 10 consecutive patients were treated in our proctology department for complex fistulas with anal fistula plugs and were evaluated with subsequent follow-up. During the operation the fistula tract was identified and the plug was inserted and fixed by internal and external sutures. Results: Ten patients, with a median age 40.8 years were included. There were 6 males and 4 females. At median length of follow-up of 12 months (range: 8 to 16 months) 5 of the 10 fistulas had healed (50%). Conclusion: The anal fistula plug is successful in the treatment of anorectal fistulas. Due to its low morbidity rate the insertion of anal fistula plugs should be considered instead of surgery.