Introduction Complex anal fistulas, unlike simple fistulas, are more difficult to treat because fistulotomy would predictably result in incontinence. The purpose of this study was to compare the use of novel surgical approaches, involving fibrin glue and the anal fistula plug, with that of conventional surgical approaches, involving an extensive fistulomy and flap closure or seton drain insertion, in the management of patients with complex anal fistulas (high to mid-transsphincteric, horseshoe, suprasphincteric, Crohn's, recurring). In all approaches, care is taken to preserve anal continence.
Methods This is a retrospective cohort study of all patients treated for complex anal fistulas by a single colorectal surgeon at the University of British Columbia from 1997 to 2006. The primary outcome was full healing (external fistula opening closed with no drainage or infection) at 3 months postoperatively. Preservation of continence was a secondary outcome.
Results There were 45 males and 20 females with a median age of 43 (range 21-75). Fifteen patients were treated by flap closure and fistulotomy external to the sphincter, 33 underwent seton drain insertion and fistulotomy external to the sphincter, 10 were injected with fibrin glue, and 7 had insertion of a fistula plug. Full healing rates were 47% for flap closure, 15% for seton drainage, 30% for fibrin glue, and 57% for plug insertion. Continence was preserved in all patients
Conclusions Closure of the primary fistula opening using a biologic anal fistula plug provides an alternate simple method of treating complex anal fistulas. Although only a small number of patients have undergone this new procedure, these are promising preliminary outcomes.
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