A retrospective review of chronic anal fistulae treated by anal fistulae plug

Objective The aim of this study was to analyse the efficacy of the anal fistulae plug (Cook Surgisis (R) AFP (TM)) for the management of complex anal fistulae. Method A review of patients with anal fistulae treated using Cook Surgisis (R) AFP (TM) between October 2005 and 2007 was undertaken. Patient's demographics, fistulae aetiology and success rates were recorded. Results Thirty-three patients underwent 49 plug insertions. The median age was 44.4 years; 18 females. The fistulae aetiology was cryptoglandular in 61% and Crohn's disease in 39%. The median follow up 221.5 days (range 44-684). Twenty-one patients had previous failed surgery. Twenty-eight patients had draining setons in situ at time of plug placement. The overall success rate was 8/32 patients (25%). Two of the 22 Crohn's fistulae healed (9.1%) and 9/26(34.6%) cryptoglandular fistulae healed. The reasons for failure were sepsis in 87% and plug dislodgement in 13%. Significant predictor factors for improved outcome were African-Americans patients (P = 0.009), and presence of seton (P = 0.05). Conclusions Anal fistulae plug was associated with a lower success rate than previously reported. Septic complications were the main reason for failure.