Long-term outcome of the anal fistula plug for complex cryptoglandular and Crohn's fistulas.

AIM To evaluate the long-term success rate of the anal fistula plug for complex anal fistulas, assess fistula plug failure over time and compare success rates of the cryptoglandular fistula group with the Crohn's fistula group. METHOD This is a single-centre study of consecutive patients treated with the 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 3-D endoanal ultrasound and treated with a loose seton. Postoperative assessment by clinical examination and 3-D endoanal ultrasound was done at 2 weeks, 3 months and 6 to 12 months. Long-term follow-up was carried out with a questionnaire and clinical examination combined with 3-D endoanal ultrasound, if the questionnaire indicated any signs of fistula recurrence. RESULTS A total of 95 patients were included; 30 with quiescent Crohn's disease. 151 plug procedures were performed on these patients. The long-term follow-up was completed for 90 (95%) patients. After a median follow-up period of 110 months, the overall healing rate after one to five plug procedures was 38%. No statistically significant difference was seen in success rates 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.