Treatment of Fistula-In-Ano with Fistula Plug?-?a Review Under Special
Consideration of the Technique
#MMPMID26528482
Köckerling F
; Alam NN
; Narang SK
; Daniels IR
; Smart NJ
Front Surg
2015[]; 2
(?): 55
PMID26528482
show ga
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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