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Fitzpatrick DP, Kealey C, Brady D, Gately N. Application of biomaterials for complex anal fistulae. INT J POLYM MATER PO 2021. [DOI: 10.1080/00914037.2021.1999955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Daniel P. Fitzpatrick
- Material Research Institute, Athlone Institute of Technology, Athlone, Ireland
- Department of Life and Physical Science, Athlone Institute of Technology, Athlone, Ireland
| | - Carmel Kealey
- Department of Life and Physical Science, Athlone Institute of Technology, Athlone, Ireland
- Bioscience Research Institute, Athlone Institute of Technology, Athlone, Ireland
| | - Damien Brady
- Department of Life and Physical Science, Athlone Institute of Technology, Athlone, Ireland
- Department of Science and Health, Institute of Technology Carlow, Carlow, Ireland
| | - Noel Gately
- Material Research Institute, Athlone Institute of Technology, Athlone, Ireland
- Applied Polymer Technologies Gateway Centre, Athlone Institute of Technology, Athlone, Ireland
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Jayne DG, Scholefield J, Tolan D, Gray R, Senapati A, Hulme CT, Sutton AJ, Handley K, Hewitt CA, Kaur M, Magill L. A Multicenter Randomized Controlled Trial Comparing Safety, Efficacy, and Cost-effectiveness of the Surgisis Anal Fistula Plug Versus Surgeon's Preference for Transsphincteric Fistula-in-Ano: The FIAT Trial. Ann Surg 2021; 273:433-441. [PMID: 32516229 DOI: 10.1097/sla.0000000000003981] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To undertake a randomized comparison of the Biodesign Surgisis anal fistula plug against surgeon's preference in treating cryptoglandular transsphincteric fistula-in-ano. SUMMARY BACKGROUND DATA The efficacy of the Biodesign Surgisis anal fistula plug in healing anal fistulae is uncertain. METHODS Participants were randomized to the fistula plug with surgeon's preference (advancement flap, cutting seton, fistulotomy, Ligation of the Intersphincteric Fistula Tract procedure). The primary outcome was faecal incontinence quality of life (FIQoL) at 12-months. Secondary outcomes were fistula healing, incontinence rates, and complication and reintervention rates. RESULTS Between May 2011 and March 2016, 304 participants were randomized to fistula plug or surgeon's preference. No differences were seen in FIQoL between the 2 groups at 12 months. Clinical fistula healing was reported in 66/122 (54%) of the fistula plug and 66/119 (55%) of the surgeon's preference groups at 12 months. Fecal incontinence rates improved marginally in both the groups. Complications and reinterventions were frequent, with significantly more complications in the fistula plug group at 6-weeks (49/142, 35% vs 25/137, 18%; P=0.002). The mean total costs were £2738 (s.d. £1151) for the fistula plug and £2308 (s.d. £1228) for the surgeon's preference group (mean difference +£430, P=0.0174). The average total quality adjusted life years (QALYs) gained was marginally higher in the fistula plug group. The fistula plug was 35% to 45% likely to be cost-effective across a willingness to pay threshold of £20,000 to £30,000 / QALY. CONCLUSIONS The Biodesign Surgisis anal fistula plug is associated with similar FIQoL and healing rates to surgeon's preference at 12 months. Higher costs and highly uncertain gains in QALYs mean that the fistula plug may not be considered as a cost-effective treatment in the UK NHS.
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Affiliation(s)
| | | | | | - Richard Gray
- Nuffield Department of Population Health Medicine Sciences Division, University of Oxford, Oxford, UK
| | | | - Claire T Hulme
- Academic Unit of Health Economics, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | | | - Kelly Handley
- Birmingham Clinical Trials Unit (BCTU), University of Birmingham, Birmingham, UK
| | - Catherine A Hewitt
- Birmingham Clinical Trials Unit (BCTU), University of Birmingham, Birmingham, UK
| | - Manjinder Kaur
- Birmingham Clinical Trials Unit (BCTU), University of Birmingham, Birmingham, UK
| | - Laura Magill
- Birmingham Clinical Trials Unit (BCTU), University of Birmingham, Birmingham, UK
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Aho Fält U, Zawadzki A, Starck M, Bohe M, Johnson LB. Long-term outcome of the Surgisis ® (Biodesign ® ) anal fistula plug for complex cryptoglandular and Crohn's fistulas. Colorectal Dis 2021; 23:178-185. [PMID: 33155391 PMCID: PMC7898619 DOI: 10.1111/codi.15429] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Revised: 09/25/2020] [Accepted: 10/03/2020] [Indexed: 12/14/2022]
Abstract
AIM To evaluate the long-term success rate of treatment with the Surgisis® (Biodesign® ) anal fistula plug for complex anal fistulas, assess fistula plug failure over time and compare success rates for fistula plug between a group of patients with cryptoglandular fistula and another group with Crohn's fistula. METHOD This is a single-centre study of consecutive patients treated with the Surgisis® (Biodesign® ) anal fistula plug between May 2006 and October 2009. All patients had complex anal fistulas in need of surgical treatment. The patients were assessed preoperatively by physical examination and three-dimensional (3D) endoanal ultrasound, and treated with a loose seton. Postoperative assessment by clinical examination and 3D endoanal ultrasound was performed at 2 weeks, 3 months and 6-12 months. Long-term follow-up was carried out in 2017 using a questionnaire, and clinical examination combined with 3D endoanal ultrasound was performed if the questionnaire indicated any signs of fistula recurrence. RESULTS A total of 95 patients were included; 30 had quiescent Crohn's disease. Overall, 151 plug procedures were performed. Long-term follow-up was undertaken in 90 (95%) patients; the results showed that after a median period of 110 months, the overall healing rate after one to five plug procedures was 38%. No statistically significant difference in success rate was found between the cryptoglandular fistula group and the Crohn's fistula group (P = 0.37). No further healing was observed after the use of three plugs. CONCLUSION Considering its low morbidity in a complex disease with high recurrence rates over time, the anal fistula plug may still be considered as one of the first-line treatments for patients with complex anal fistulas.
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Affiliation(s)
- Ursula Aho Fält
- Department of SurgeryPelvic Floor CentreSkåne University Hospital – MalmöLund UniversityMalmöSweden
| | - Antoni Zawadzki
- Department of SurgeryPelvic Floor CentreSkåne University Hospital – MalmöLund UniversityMalmöSweden
| | - Marianne Starck
- Department of SurgeryPelvic Floor CentreSkåne University Hospital – MalmöLund UniversityMalmöSweden
| | - Måns Bohe
- Department of SurgeryPelvic Floor CentreSkåne University Hospital – MalmöLund UniversityMalmöSweden
| | - Louis B. Johnson
- Department of SurgeryPelvic Floor CentreSkåne University Hospital – MalmöLund UniversityMalmöSweden
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Tao Y, Zheng Y, Han JG, Wang ZJ, Cui JJ, Zhao BC, Yang XQ. Long-Term Clinical Results of Use of an Anal Fistula Plug for Treatment of Low Trans-Sphincteric Anal Fistulas. Med Sci Monit 2020; 26:e928181. [PMID: 33279927 PMCID: PMC7727077 DOI: 10.12659/msm.928181] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND An anal fistula plug is a sphincter-sparing procedure that uses biological substances to close an anorectal fistula. This study aimed to evaluate the long-term therapeutic effect of an anal fistula plug procedure in patients with trans-sphincteric fistula-in-ano and to determine the risk factors affecting fistula healing. MATERIAL AND METHODS A single-center retrospective study was performed assessing long-term treatment outcomes of patients with low trans-sphincteric anal fistulas who initially underwent anal fistula plug procedures between August 2008 and September 2012. Risk factors affecting fistula healing were identified using univariate and multivariate analyses. RESULTS A total of 135 patients who had low trans-sphincteric anal fistulas and underwent anal fistula plug procedures were analysed. The overall healing rate was 56% (75/135) with a median follow-up time of 8 years (range, 72-121 months). The primary reasons for treatment failure were plug extrusion (n=12, 20%) and surgical site infection (n=9, 15%), occurring within 30 days after surgery. Multiple logistic regression analysis showed that the duration of anal fistula ≥6 months was significantly associated with treatment failure using an anal fistula plug (OR=3.187, 95% CI: 1.361-7.466, P=0.008). Of the patients who failed initial treatment with an anal fistula plug, 6 (9%) had anal fistulas that healed spontaneously after 2-3 years without additional treatment. CONCLUSIONS As a sphincter-preserving procedure, the anal fistula plug can effectively promote healing of low trans-sphincteric anal fistulas. The long-term efficacy is good and the procedure warrants wider use in clinical practice.
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Affiliation(s)
- Yu Tao
- Department of General Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China (mainland)
| | - Yi Zheng
- Department of General Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China (mainland)
| | - Jia Gang Han
- Department of General Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China (mainland)
| | - Zhen Jun Wang
- Department of General Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China (mainland)
| | - Jin Jie Cui
- Department of General Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China (mainland)
| | - Bao Cheng Zhao
- Department of General Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China (mainland)
| | - Xin Qing Yang
- Department of General Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China (mainland)
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Smith TA, Hardman RL, Jenkins L, Marashi K, O'Hara R, Cizman Z. Extracellular Matrix Enterocutaneous Fistula Plugs Show Promise for Low-Flow Colocutaneous and Enterocutaneous Fistulae. J Vasc Interv Radiol 2020; 32:128-134. [PMID: 33229185 DOI: 10.1016/j.jvir.2020.08.033] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Revised: 08/08/2020] [Accepted: 08/30/2020] [Indexed: 11/16/2022] Open
Abstract
PURPOSE To evaluate extracellular matrix enterocutaneous fistula plugs (ECMFPs) in treatment of enteric fistulae at a single institution. MATERIALS AND METHODS The study included 18 patients who had an ECMFP placed between 2012 and 2018 with treatment follow-up through July 2020. Median patient age was 52.5 years (interquartile range, 11.5 y). There were 28 ECMFP procedures performed on 19 separate fistulae. Fistulae locations were gastrocutaneous (n = 4), enterocutaneous (n = 9), and colocutaneous (n = 6). Descriptive statistics were used to define closure rates, recurrence rates, and complications. RESULTS Fistula closure was achieved in 1 of 4 gastrocutaneous (25%), 4 of 9 enterocutaneous (44%), and 3 of 6 colocutaneous (50%) locations. The median time from procedure to fistula tract closure was 29 days interquartile range 25 days. The median time from ECMFP placement to fistula recurrence was 28 days (interquartile range 27 days). Of the fistulae that eventually closed, 6 of 8 closed after the first attempt (75%), and 2 closed after the second attempt (25%). Of the procedures that resulted in complete closure, 7 of 8 were categorized as low flow, and 1 of 8 was categorized as high flow. Complications were seen in 4 patients (23%), with major complications in 3 patients (17%). CONCLUSIONS Low-flow fistulae originating from the small bowel are most likely to have complete closure. High-flow and/or gastrocutaneous fistulae are less likely to benefit from this intervention. In patients who are not surgical candidates or who have failed surgical management, ECMFPs may provide a solution.
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Affiliation(s)
- Tyler A Smith
- Department of Radiology and Imaging Sciences, University of Utah Hospital, Salt Lake City, Utah
| | - Rulon L Hardman
- Department of Radiology, Dartmouth-Hitchcock Medical Center, 1 Medical Center Drive, Lebanon, NH 03766.
| | - Luke Jenkins
- Department of Radiology and Imaging Sciences, University of Utah Hospital, Salt Lake City, Utah
| | - Keyan Marashi
- Department of Radiology and Imaging Sciences, University of Utah Hospital, Salt Lake City, Utah
| | - Ryan O'Hara
- Department of Radiology and Imaging Sciences, University of Utah Hospital, Salt Lake City, Utah
| | - Ziga Cizman
- Department of Radiology and Imaging Sciences, University of Utah Hospital, Salt Lake City, Utah
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Jayne DG, Scholefield J, Tolan D, Gray R, Edlin R, Hulme CT, Sutton AJ, Handley K, Hewitt CA, Kaur M, Magill L. Anal fistula plug versus surgeon's preference for surgery for trans-sphincteric anal fistula: the FIAT RCT. Health Technol Assess 2020; 23:1-76. [PMID: 31113531 DOI: 10.3310/hta23210] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND The aim of fistula surgery is to eradicate the disease while preserving anal sphincter function. The efficacy of the Surgisis® anal fistula plug (Cook Medical, Bloomington, IN, USA) in the treatment of trans-sphincteric fistula-in-ano has been variably reported. OBJECTIVES To undertake a randomised comparison of the safety and efficacy of the Surgisis anal fistula plug in comparison with surgeon's preference for the treatment of trans-sphincteric anal fistulas. DESIGN A randomised, unblinded, parallel-arm, prospective, multicentre clinical trial. SETTING Hospitals in the UK NHS involving colorectal surgeons accredited by the Association of Coloproctology of Great Britain and Ireland. PARTICIPANTS Adult patients suffering from trans-sphincteric fistula-in-ano of cryptoglandular origin. INTERVENTIONS Patients were randomised on a 1 : 1 basis to either the fistula plug or the surgeon's preference [e.g. fistulotomy, cutting seton, advancement flap or ligation of intersphincteric fistula tract (LIFT) procedure]. MAIN OUTCOME MEASURES The primary outcome measure was quality of life as measured by the Faecal Incontinence Quality of Life (FIQoL) questionnaire at 12-month follow-up. Secondary outcome measures included clinical and radiological fistula healing rates, faecal incontinence rates, complications rates, reintervention rates and cost-effectiveness. RESULTS Between May 2011 and March 2016, 304 participants were recruited (152 fistula plug vs. 152 surgeon's preference). No difference in FIQoL score between the two trial groups was seen at the 6-week, 6-month or 12-month follow-up. Clinical evidence of fistula healing was reported in 66 of 122 (54%) participants in the fistula plug group and in 66 of 119 (55%) participants in the surgeon's preference group at 12 months. Magnetic resonance imaging (MRI) showed fistula healing in 54 of 110 (49%) participants in the fistula plug group and in 63 of 112 (56%) participants in the surgeon's preference group. Variation in 12-month clinical healing rates was observed: 55%, 64%, 75%, 53% and 42% for fistula plug, cutting seton, fistulotomy, advancement flap and LIFT procedure, respectively. Faecal incontinence rates were low at baseline, with small improvement in both groups post treatment. Complications and reinterventions were frequent. The mean total costs were £2738 [standard deviation (SD) £1151] in the fistula plug group and £2308 (SD £1228) in the surgeon's preference group. The average total quality-adjusted life-years (QALYs) gain was much smaller in the fistula plug group (0.829, SD 0.174) than in the surgeon's preference group (0.790, SD 0.212). Using multiple imputation and probabilistic sensitivity analysis, and adjusting for differences in baseline EuroQol-5 Dimensions, three-level version utility, there was a 35-45% chance that the fistula plug was as cost-effective as surgeon's preference over a range of thresholds of willingness to pay for a single QALY of £20,000-30,000. LIMITATIONS Limitations include a smaller sample size than originally calculated, a lack of blinding that perhaps biased patient-reported outcomes and a lower compliance rate with MRI at 12-month follow-up. CONCLUSIONS The Surgisis anal fistula plug is associated with similar FIQoL score to surgeon's preference at 12-month follow-up. The higher costs and highly uncertain and small gains in QALYs associated with the fistula plug mean that this technology is unlikely to be considered a cost-effective use of resources in the UK NHS. FUTURE WORK Further in-depth analysis should consider the clinical and MRI characteristics of fistula-in-ano in an attempt to identify predictors of fistula response to treatment. TRIAL REGISTRATION Current Controlled Trials ISRCTN78352529. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 23, No. 21. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- David G Jayne
- Leeds Institute of Medical Research at St James's, University of Leeds, Leeds, UK
| | | | - Damian Tolan
- Leeds Institute of Medical Research at St James's, University of Leeds, Leeds, UK
| | - Richard Gray
- Nuffield Department of Population Health Medicine Sciences Division, University of Oxford, Oxford, UK
| | - Richard Edlin
- Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Claire T Hulme
- Academic Unit of Health Economics, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Andrew J Sutton
- Academic Unit of Health Economics, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Kelly Handley
- Birmingham Clinical Trials Unit, University of Birmingham, Birmingham, UK
| | - Catherine A Hewitt
- Birmingham Clinical Trials Unit, University of Birmingham, Birmingham, UK
| | - Manjinder Kaur
- Birmingham Clinical Trials Unit, University of Birmingham, Birmingham, UK
| | - Laura Magill
- Birmingham Clinical Trials Unit, University of Birmingham, Birmingham, UK
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Hansen MS, Kjær ML, Andersen J. Efficacy of Plug Treatment for Complex Anorectal Fistulae: Long-term Danish Results. Ann Coloproctol 2019:123-128. [PMID: 30889947 PMCID: PMC6625774 DOI: 10.3393/ac.2018.07.14] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Accepted: 07/14/2018] [Indexed: 12/11/2022] Open
Abstract
Purpose Bioprosthetic plugs are appealing, allow simple, repeatable applications, preserve sphincter integrity, minimize patient discomfort, and allow subsequent surgical options when needed. However, success rates vary widely. This study assessed the healing rate in our department when both the Cook-Surgisis and the Gore fistula plugs were used and the long-term effectiveness of using anal plugs for managing anal fistulae. Methods A chart review was performed for patients who had undergone plug insertion between January 2008 and December 2015 at Copenhagen University Hospital, Hvidovre. Data were collected through a prospectively collected database. Plugs were inserted according to guidance provided by 2 experienced surgeons. Long-term results were determined by clinical visits 3, 6, and 12 months after surgery and once yearly thereafter. Results From 2008 to 2015, 36 fistula plugs were inserted. During the follow-up period with a median duration of 18 months (range, 7-60 months), the fistulae of 52.8% of the patients healed. The plug failure rate was 44.4%, and the fistula recurrence rate was 26.3%. The median time to recurrence was 12 months. The overall success rate for plug treatment in our department was 39% when adjusted for recurrence. Conclusion The use of bioprosthetic plugs to treat patients with complex anal fistulae seems to be a safe, viable option for complex fistula repair when other surgical attempts have failed. However, it should not be the treatment of choice. Further prospective randomized studies with a sufficient sample-size and standardized measurements are necessary to evaluate the efficacy of fistula plugs fully.
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Affiliation(s)
- Melina Svraka Hansen
- Copenhagen University Hospital, Hvidovre, Gastro Unit, Centre for Surgical Research, Hvidovre, Denmark
| | - Monica Linda Kjær
- Copenhagen University Hospital, Hvidovre, Gastro Unit, Centre for Surgical Research, Hvidovre, Denmark
| | - Jens Andersen
- Copenhagen University Hospital, Hvidovre, Gastro Unit, Centre for Surgical Research, Hvidovre, Denmark
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Ommer A, Herold A, Berg E, Farke S, Fürst A, Hetzer F, Köhler A, Post S, Ruppert R, Sailer M, Schiedeck T, Schwandner O, Strittmatter B, Lenhard BH, Bader W, Krege S, Krammer H, Stange E. S3-Leitlinie: Kryptoglanduläre Analfisteln. COLOPROCTOLOGY 2016. [DOI: 10.1007/s00053-016-0110-7] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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Results of the Gore Bio-A fistula plug implantation in the treatment of anal fistula: a multicentre study. Tech Coloproctol 2016; 20:585-90. [PMID: 27418257 DOI: 10.1007/s10151-016-1505-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2016] [Accepted: 05/05/2016] [Indexed: 12/22/2022]
Abstract
BACKGROUND The aim of this prospective study was to determine the efficiency of the Gore Bio-A synthetic plug in the treatment of anal fistulas. METHODS A synthetic bioabsorbable anal fistula plug was implanted in 60 patients. All fistulas were transsphincteric and cryptoglandular in origin. RESULTS The healing rate after 1 year of follow-up was 52 % (31 out of 60 patients). No patient was lost to follow-up. The treatment had no effect on the incontinence score. The plug dislodgement rate was 10 % (6 out of 60 patients). Thirty-four per cent of the patients (16 out of 47) required reoperation. The average operating time was 32 ± 10.2 min, and the average length of hospital stay was 3.3 ± 1.8 days. CONCLUSIONS Synthetic plugs may be an alternative to bioprosthetic fistula plugs in the treatment of transsphincteric anal fistulas. This method might have better success rates than treatment with bioprosthetic fistula plugs.
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Köckerling F, Alam NN, Narang SK, Daniels IR, Smart NJ. Treatment of Fistula-In-Ano with Fistula Plug - a Review Under Special Consideration of the Technique. Front Surg 2015; 2:55. [PMID: 26528482 PMCID: PMC4607815 DOI: 10.3389/fsurg.2015.00055] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2015] [Accepted: 09/30/2015] [Indexed: 12/13/2022] Open
Abstract
Introduction In a recent Cochrane review, the authors concluded that there is an urgent need for well-powered, well-conducted randomized controlled trials comparing various modes of treatment of fistula-in-ano. Ten randomized controlled trials were available for analyses: There were no significant differences in recurrence rates or incontinence rates in any of the studied comparisons. The following article reviews the studies available for treatment of fistula-in-ano with a fistula plug with special attention paid to the technique. Material and Methods PubMed, Medline, Embase, and the Cochrane medical database were searched up to July 2015. Sixty-four articles were relevant for this review. Results Healing rates of 50–60% can be expected for treatment of complex anal fistula with a fistula plug, with a plug-extrusion rate of 10–20%. Such results can be achieved not only with plugs made of porcine intestinal submucosa but also those made of other biological or synthetic bioabsorbable mesh materials. Important technical steps are firm suturing of the head of the plug in the primary opening and wide drainage of the secondary opening. Discussion Treatment of a complex fistula-in-ano with a fistula plug is an option with a success rate of 50–60% with low complication rate. Further improvements in technique and better studies are needed.
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Affiliation(s)
- Ferdinand Köckerling
- Department of Surgery and Center for Minimally Invasive Surgery, Academic Teaching Hospital of Charité Medical School, Vivantes Hospital , Berlin , Germany
| | - Nasra N Alam
- Exeter Surgical Health Services Research Unit (HeSRU), Royal and Exeter Hospital , Exeter , UK
| | - Sunil K Narang
- Exeter Surgical Health Services Research Unit (HeSRU), Royal and Exeter Hospital , Exeter , UK
| | - Ian R Daniels
- Exeter Surgical Health Services Research Unit (HeSRU), Royal and Exeter Hospital , Exeter , UK
| | - Neil J Smart
- Exeter Surgical Health Services Research Unit (HeSRU), Royal and Exeter Hospital , Exeter , UK
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Iorio T, Blumberg D. Short-Term Results of Treating Primary and Recurrent Anal Fistulas with a Novel Extracellular Matrix Derived from Porcine Urinary Bladder. Am Surg 2015. [DOI: 10.1177/000313481508100532] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Anal fistulas are difficult to treat because they are often recalcitrant to medical therapies and surgical treatment may lead to significant morbidities. A recent novel biologically derived graft from porcine urinary bladder (MatriStem™) has shown great promise in experimental studies of tissue regeneration in diverse tissues. The objectives of this study were to evaluate the safety and short-term efficacy of MatriStem for treatment of anal fistulas. This was a retrospective study of patients treated from January 3, 2012 to March 3, 2014 at the University of Pittsburgh Medical Center. MatriStem was used to treat patients with anal fistulas by implanting it uniformly with a single application in all patients using a standardized protocol. Data were collected retrospectively from hospital records and office charts. Nineteen fistulas were treated with MatriStem. There were no adverse complications. Overall efficacy of MatriStem was 79 per cent with healing occurring in a mean time of 17 days and mean follow-up of seven months (range 1–26 months). MatriStem was effective in healing in 75 per cent of primary anal fistulas and 86 per cent of recurrent fistulas. MatriStem seems to be a safe and promising treatment for primary and recurrent anal fistulas, and warrants further study and clinical trials to substantiate widespread clinical use.
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Affiliation(s)
- Tara Iorio
- Bandaid Surgery, PC, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - David Blumberg
- Bandaid Surgery, PC, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
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12
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Prospective multicenter study of a synthetic bioabsorbable anal fistula plug to treat cryptoglandular transsphincteric anal fistulas. Dis Colon Rectum 2015; 58:344-51. [PMID: 25664714 DOI: 10.1097/dcr.0000000000000288] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Although interest in sphincter-sparing treatments for anal fistulas is increasing, few large prospective studies of these approaches have been conducted. OBJECTIVE The study assessed outcomes after implantation of a synthetic bioabsorbable anal fistula plug. DESIGN A prospective, multicenter investigation was performed. SETTING The study was conducted at 11 colon and rectal centers. PATIENTS Ninety-three patients (71 men; mean age, 47 years) with complex cryptoglandular transsphincteric anal fistulas were enrolled. Exclusion criteria included Crohn's disease, an active infection, a multitract fistula, and an immunocompromised status. INTERVENTION Draining setons were used at the surgeon's discretion. Patients had follow-up evaluations at 1, 3, 6, and 12 months postoperatively. MAIN OUTCOME MEASURES The primary end point was healing of the fistula, defined as drainage cessation plus closure of the external opening, at 6 and 12 months. Secondary end points were fecal continence, duration of drainage from the fistula, pain, and adverse events during follow-up. RESULTS Thirteen patients were lost to follow-up and 21 were withdrawn, primarily to undergo an alternative treatment. The fistula healing rates at 6 and 12 months were 41% (95% CI, 30%-52%; total n = 74) and 49% (95% CI, 38%-61%; total n = 73). Half the patients in whom a previous treatment failed had healing. By 6 months, the mean Wexner score had improved significantly (p = 0.0003). By 12 months, 93% of patients had no or minimal pain. Adverse events included 11 infections/abscesses, 2 new fistulas, and 8 total and 5 partial plug extrusions. The fistula healed in 3 patients with a partial extrusion. LIMITATIONS The study was nonrandomized and had relatively high rates of loss to follow-up. CONCLUSION Implantation of a synthetic bioabsorbable fistula plug is a reasonably efficacious treatment for complex transsphincteric anal fistulas, especially given the simplicity and low morbidity of the procedure.
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