Evidence - Anal fistula, closure with Anal Fistula Plug® (AFP®)

Coming from the United States, the Anal Fistula Plug® was introduced in Germany in 2006. A slender cylinder made of porcine collagen is used to occlude the fistula tract from the inside. Contrary to other surgical techniques, no extensive excision of fistula tissue is required, which simplifies the operation and results only in small postoperative wounds. After initially rather euphoric reports with healing rates of more than 85%, recent publications demonstrate healing rates between 30% and 70% (O'Connell, Johnson). At present, it is not yet possible to reach a definitive conclusion. Multicenter randomized trials have been initiated.

LATFIA-trial: Laser Assisted Treatment of Fistula In Ano Randomized Controlled Trial Comparing FiLaCTM to Rectal Advancement Flap

The Outcome of Combined Partial Fistulectomy or Fistulotomy and Cutting Seton Procedure in High Perianal Fistula: Prospective Study

External Anal Sphincter-Sparing Seton After Rerouting Versus Ligation of Intersphincteric Fistula Tract (LIFT) In Treatment Of Complex Anal Fistula: A Randomized Clinical Trial

1. Johnson E, Janette U, Gaw J, Armstrong DN: Efficacy of Anal fistula plug vs. fibrin glue in closure of anorectal fistulas; Dis Colon Rectum 2006; 49: 371-376
2. O´Connor L, Champagne BJ, Ferguson MA, Orangio GR, Schertzer ME, Armstrong DN: Efficacy of Anal Fistula Plug in Closure of Crohn´s Anorectal Fistulas; Dis Colon Rectum 2006; 49: 1569–1573
3. Champagne BJ, O´Connor LM, Ferguson M, Orangio GR, Schertzer ME, Armstrong DN: Efficacy of Anal Fistula Plug in Closure of Cryptoglandular Fistulas: Long-Term Follow-Up; Dis Colon Rectum 2006; 49: 1817–1821
4. Ellis CN: Bioprosthetic Plugs for Complex Anal Fistulas: An Early Experience Journal of Surgical Education 2007; 64: 36-40
5. Van Koperen P, Hoore A, Wolthuis A et al.: Anal Fistula Plug for Closure of Difficult Anorectal Fistula: A Prospective Study; Dis Colon Rectum 2007; 50: 2168–2172.
6. Schwandner O, Stadler F, Dietl O, Wirsching RP, Fuerst A: Initial experience on efficacy in closure of cryptoglandular and Crohn’s transsphincteric fistulas by the use of the anal fistula plug; Int J Colorectal Dis 2008; 23:319–324