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

Originating from the USA, the Anal Fistula Plug® was introduced in Germany in 2006. Using a narrow cylinder made from porcine collagen, the fistula tract is occluded from the inside. Unlike other surgical techniques, extensive removal of fistula tissue is avoided, simplifying the operation and resulting in only small postoperative wounds. Initially, very enthusiastic reports claimed healing rates of over 85%, but randomized studies have only achieved healing rates of 20-30%. Therefore, the plug is now used only in a few cases as one of several options for high fistulas.

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
7. Ortiz H, Marzo J, Ciga MA, Oteiza F, Armendariz P, deMiguel M (2009) Randomized clinical trial of anal fistula plug versus endorectal advancement flap for the treatment of high cryptoglandular fistula in ano. Br J Surg 96:608-612

Iqbal N, Shah R, Alrubaiy L, Tozer P. Do Patient-Reported Quality-of-Life (QoL) Scales Provide an Adequate Assessment of Patients with Cryptoglandular Anal Fistulae? A Systematic Review of Measurement Instruments and Their Content Validity. Clin Pract. 2022 Aug 15;12(4):628-639.

Garg P. Comparison between recent sphincter-sparing procedures for complex anal fistulas-ligation of intersphincteric tract vs transanal opening of intersphincteric space. World J Gastrointest Surg. 2022 May 27;14(5):374-382.

Sarveazad A, Bahardoust M, Shamseddin J, Yousefifard M. Prevalence of anal fistulas: a systematic review and meta-analysis. Gastroenterol Hepatol Bed Bench. 2022 Winter;15(1):1-8.

 Elfallal AH, Fathy M, Elbaz SA, Emile SH. Comprehensive literature review of the  applications of surgical laser in benign anal conditions. Lasers Med Sci. 2022 Sep;37(7):2775-2789

Tsuji Y, Takano S, Yamada K, Takano M. A Retrospective Critique of the Various Sphincter-preserving Surgical Procedures for Ischiorectal Fistula. J Anus Rectum  Colon. 2022 Apr 27;6(2):100-112.

Tian Z, Li YL, Nan SJ, Xiu WC, Wang YQ. Video-assisted anal fistula treatment for complex anorectal fistulas in adults: a systematic review and meta-analysis. Tech Coloproctol. 2022 Oct;26(10):783-795.

Huang H, Ji L, Gu Y, Li Y, Xu S. Efficacy and Safety of Sphincter-Preserving Surgery in the Treatment of Complex Anal Fistula: A Network Meta-Analysis. Front  Surg. 2022 Feb 8;9:825166. 

S3-Guideline: Cryptoglandular Anal Fistulas    (2016)

Japanese Practice Guidelines for Anal Disorders II. Anal fistula    (2018)

The treatment of anal fistula: second ACPGBI Position Statement    (2018)

The American Society of Colon and Rectal Surgeons Clinical Practice Guidelines for the Management of Anorectal Abscess, Fistula-in-Ano, and Rectovaginal Fistula    (2022)