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06 December 2020 : Clinical Research

Long-Term Clinical Results of Use of an Anal Fistula Plug for Treatment of Low Trans-Sphincteric Anal Fistulas

Yu Tao1BCDEF, Yi Zheng1BCDEF, Jia Gang Han1ABCDEFG*, Zhen Jun Wang1ACDF, Jin Jie Cui1BF, Bao Cheng Zhao1BF, Xin Qing Yang1AD

DOI: 10.12659/MSM.928181

Med Sci Monit 2020; 26:e928181

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.

Keywords: Anus Diseases, Fistula, Risk Factors, Treatment Outcome

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Medical Science Monitor eISSN: 1643-3750
Medical Science Monitor eISSN: 1643-3750