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 AFP) for the management of complex anal fistulae.

Methods: A review of patients with anal fistulae treated using Cook Surgisis AFP 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.