Document Detail


Anal fistula plug is a valid alternative option for the treatment of complex anal fistula in the long term.
MedLine Citation:
PMID:  20556403     Owner:  NLM     Status:  In-Process    
Abstract/OtherAbstract:
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, 1.3 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.
Authors:
Leonardo Lenisa; Eloy Espìn-Basany; Andrea Rusconi; Luigi Mascheroni; Jordi Escoll-Rufino; Roberto Lozoya-Trujillo; Francesc Vallribera-Valls; Jacques Mégevand
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Publication Detail:
Type:  Journal Article     Date:  2010-06-17
Journal Detail:
Title:  International journal of colorectal disease     Volume:  25     ISSN:  1432-1262     ISO Abbreviation:  Int J Colorectal Dis     Publication Date:  2010 Dec 
Date Detail:
Created Date:  2010-11-05     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8607899     Medline TA:  Int J Colorectal Dis     Country:  Germany    
Other Details:
Languages:  eng     Pagination:  1487-93     Citation Subset:  IM    
Affiliation:
Surgery Unit, Casa di Cura San Pio X, Via Francesco Nava, 31, 20159, Milan, Italy. leonardo_lenisa@lycos.com
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